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1.
Artículo en Inglés | MEDLINE | ID: mdl-39261242

RESUMEN

Sentinel lymph node biopsy (SLNB) is increasingly incorporated in European national guidelines for the management of the clinically node-negative neck (cN0) in early-stage oral squamous cell carcinoma (OSCC). In Germany, SLNB in OSCCs is not yet routinely performed. This study aimed to evaluate the clinical outcome of SLNB in a German cohort. Patients with primary early-stage OSCC who underwent tumor resection and SLNB were retrospectively analyzed. Clinical-pathological characteristics were documented. Primary endpoints were sensitivity and the negative predictive value (NPV). A total of 46 patients with a mean age of 62.3 (±14.5) years met the inclusion criteria. Most tumors were located in the tongue (63.0%). Bilateral drainage from a lateral tumor was observed in three cases (6.5%), and sentinel lymph node metastasis was detected in three patients (6.5%). Mean follow-up for all patients was 13.8 months (±9.6). One patient developed regional recurrence following a negative SLNB during the observation period, leading to an NPV of 0.98 and a sensitivity of 75.0%. The 2-year neck-specific relapse-free survival was 92.8%. SLNB in early-stage OSCC is a reliable diagnostic tool of the cN0 neck, ensuring a high NPV and RFS. SLNB can be advantageous in comparison to elective neck dissection due to the detection of contralateral lymph drainage.

2.
Med Sci (Basel) ; 12(3)2024 Sep 20.
Artículo en Inglés | MEDLINE | ID: mdl-39311162

RESUMEN

Osteoporosis, a skeletal disorder, is expected to affect 60% of women aged over 50 years. Dual-energy X-ray absorptiometry (DXA) scans, the current gold standard, are typically used post-fracture, highlighting the need for early detection tools. Panoramic radiographs (PRs), common in annual dental evaluations, have been explored for osteoporosis detection using deep learning, but methodological flaws have cast doubt on otherwise optimistic results. This study aims to develop a robust artificial intelligence (AI) application for accurate osteoporosis identification in PRs, contributing to early and reliable diagnostics. A total of 250 PRs from three groups (A: osteoporosis group, B: non-osteoporosis group matching A in age and gender, C: non-osteoporosis group differing from A in age and gender) were cropped to the mental foramen region. A pretrained convolutional neural network (CNN) classifier was used for training, testing, and validation with a random split of the dataset into subsets (A vs. B, A vs. C). Detection accuracy and area under the curve (AUC) were calculated. The method achieved an F1 score of 0.74 and an AUC of 0.8401 (A vs. B). For young patients (A vs. C), it performed with 98% accuracy and an AUC of 0.9812. This study presents a proof-of-concept algorithm, demonstrating the potential of deep learning to identify osteoporosis in dental radiographs. It also highlights the importance of methodological rigor, as not all optimistic results are credible.


Asunto(s)
Inteligencia Artificial , Aprendizaje Profundo , Osteoporosis , Radiografía Panorámica , Humanos , Osteoporosis/diagnóstico por imagen , Femenino , Persona de Mediana Edad , Anciano , Masculino , Redes Neurales de la Computación , Absorciometría de Fotón , Mandíbula/diagnóstico por imagen
3.
Craniomaxillofac Trauma Reconstr ; 17(3): 214-224, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39345950

RESUMEN

Study Design: Retrospective, descriptive observational study. Objective: The need for revision surgery after mandibular fractures is an indicator for severe postoperative complications. This study aimed to characterise this patient cohort, describe solutions to deal with complications and evaluate treatment quality as a risk variable for complications. Methods: Patients with revision surgery with refixation after open reduction and internal fixation (ORIF) of a mandible fracture were included. Patient- and therapy-specific information were assessed together with postoperative complications. The quality of fixation was evaluated individually by 6 specialists. Interobserver agreement was analysed using Fleiss' kappa. Results: Out of 630 patients, inclusion criteria were met by 17 patients (14 male, 3 female) with an average age of 43.3 (±15.5) years. Complications at the mandible body/angle/symphysis led to refixation in all cases. Main indications for refixation were osteomyelitis (52.9%) or pseudarthrosis (41.2%). Risk factors were drug-related immune suppression, local infection or substance abuse (nicotine, alcohol or drugs). Six patients did not present any of these predictors. Of these, treatment of 4 patients was rated as not in accordance to the AO principles. The interrater reliability of treatment quality assessments was .239. Conclusions: Patients with risk factors need to be carefully observed perioperatively after ORIF of mandibular fractures and treatments need to be adapted to these patients. Discrepancies of treatments to common guidelines may also be an independent predictor for treatment failure in patients without risk factors. Current treatment guidelines should be re-evaluated concerning additional treatment strategies for patients with specific risk factors.

4.
Front Oncol ; 14: 1438269, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39323993

RESUMEN

Objective: Miniplates offer superior clinical handling and facilitate postoperative removal after mandibular reconstruction but unfavorable load distribution under high stress has been shown. This study aimed to compare the clinical outcome of patient-specific 3D-printed (PS-3D) titanium miniplate with reconstruction plate fixation in three-segmental LCL-type reconstructions for the first time. Methods: Patients undergoing three-segmental LCL-type mandibular reconstruction after malignant tumor resection between April 2017 and July 2023 were analyzed in a retrospective single-center study. Inclusion criteria were primary reconstruction using a fibula free flap and PS-3D titanium mini- or reconstruction plate fixation. Complication rates were recorded and analyzed within 6 months after surgery using the N - 1 Chi2- and unequal variance t-test. Results: 38 patients (10 females, 28 males; mean age 61.4 ± 7.6 years) met the inclusion criteria. In 14 patients (36.8%) miniplates were used in the anterior region. Rates of fixation failure, plate exposure, incomplete osseous union, wound infection, soft tissue, and overall complications did not differ significantly between the two plate systems. Conclusion: Complication rates did not differ significantly between PS-3D mini- and reconstruction plates in three-segmental LCL-type mandibular reconstructions. Given their advantages in clinical handling and postoperative removal, PS-3D miniplates can be a viable alternative also in larger mandibular reconstructions.

5.
Clin Oral Investig ; 28(9): 466, 2024 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-39105864

RESUMEN

OBJECTIVE: Cervical lymph node metastasis (CLNM) is one of the most relevant influencing factors for the oncological outcome of patients with oral squamous cell carcinoma (OSCC). Several studies showed that the tumors depth of invasion (DOI) influences the risk for CLNM, however varying across the oral subsites. The aim of this study is to investigate the role of DOI and other risk factors in OSCC of the tongue in relation to the occurrence of occult CLNM. MATERIALS AND METHODS: In this retrospective study, n = 139 patients with primary OSCC of the tongue, treated by complete surgical resection (R0) with curative intention between 2013 and 2021, were included. For data analysis, epidemiologic data as well as preoperative tumor staging, surgical therapy including neck management, histopathological tumor data and follow-up were considered. Uni- and multivariate logistic regression were used to determine association between histopathological risk factors and the occurrence of occult CLNM. RESULTS: The rate of occult cervical metastasis was 19.4%. T-staging, cervical nodal disease (pN+) and lymphatic invasion were significantly associated with reduced OS and RFS. While DOI had no relevant influence on the OS and RFS (p = 0.88 and p = 0.91 respectively), there was significant correlation between DOI and the occurrence of occult CLNM (OR: 1.17, 95%CI: 1.05-1.30; p < 0.01). The optimal cutoff in predicting occult CLNM was 6 mm (Sensitivity: 84.2%, Specificity: 73.5%, AUC: 0.75). CONCLUSIONS: The DOI is a helpful risk parameter to predict the occurrence of occult nodal disease in OSCC of the tongue. Given the critical decision cutoff between 2 and 4 mm DOI for performing elective neck dissection in the current guidelines, our data suggests that in these cases, surgical de-escalation could be feasible with close follow-up. CLINICAL RELEVANCE: This study highlights the relevance of DOI as a risk parameter in the prediction of CLNM with the aim to specify the individual patient risk and to deescalate surgical therapy in order to decrease comorbidities while improving the oncological prognosis.


Asunto(s)
Carcinoma de Células Escamosas , Metástasis Linfática , Invasividad Neoplásica , Estadificación de Neoplasias , Neoplasias de la Lengua , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Neoplasias de la Lengua/patología , Neoplasias de la Lengua/cirugía , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Medición de Riesgo , Anciano , Factores de Riesgo , Adulto , Anciano de 80 o más Años
6.
Biomed Res Int ; 2024: 9543897, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39026517

RESUMEN

Selective neck dissection (SND) is the treatment of choice in patients with oral squamous cell carcinomas (OSCCs) and clinically node-negative necks (cN0). The treatment of patients with positive-staged necks (cN+) includes SND as well as comprehensive neck dissection (CND). The clear benefit of one or the other remains under debate. We aim to address this lack of clarity by analysing patients with OSCC staged with clinically node-positive necks, treated with either CND or SND using a level-by-level approach. This retrospective study included patients diagnosed with OSCC with clinically (cN+) and pathologically (pN+) positive cervical lymph nodes (LNs) with clear neck level categorization during the years 2010-2019. In total, 74 patients were analysed. Cox regression analysis found no significance for the type of ND being an independent risk factor, neither for overall survival (OS) nor for disease-free survival (DFS). Regional recurrence of CND cases (5.77%) was comparable to SND cases (9.09%). For OS, extracapsular spread (ECS) and male sex were identified as independent risk factors with poorer outcome. pT-stage and ECS were found to be independent risk factors for DFS. The results of this study suggest that both CND and SND may be viable treatment options for certain patients with OSCC pN+.


Asunto(s)
Carcinoma de Células Escamosas , Ganglios Linfáticos , Metástasis Linfática , Neoplasias de la Boca , Disección del Cuello , Humanos , Masculino , Femenino , Neoplasias de la Boca/cirugía , Neoplasias de la Boca/patología , Neoplasias de la Boca/mortalidad , Persona de Mediana Edad , Disección del Cuello/métodos , Anciano , Estudios Retrospectivos , Adulto , Supervivencia sin Enfermedad , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/patología , Resultado del Tratamiento , Recurrencia Local de Neoplasia/patología , Anciano de 80 o más Años , Factores de Riesgo
7.
ACS Biomater Sci Eng ; 10(8): 4901-4915, 2024 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-39072479

RESUMEN

Titanium plates are the current gold standard for fracture fixation of the mandible. Magnesium alloys such as WE43 are suitable biodegradable alternatives due to their high biocompatibility and elasticity modulus close to those of cortical bone. By surface modification, the reagibility of magnesium and thus hydrogen gas accumulation per time are further reduced, bringing plate fixation with magnesium closer to clinical application. This study aimed to compare bone healing in a monocortical mandibular fracture model in sheep with a human-standard size, magnesium-based, plasma electrolytic-oxidation (PEO) surface modified miniplate fixation system following 4 and 12 weeks. Bone healing was analyzed using micro-computed tomography and histological analysis with Movat's pentachrome and Giemsa staining. For evaluation of the tissue's osteogenic activity, polychrome fluorescent labeling was performed, and vascularization was analyzed using immunohistochemical staining for alpha-smooth muscle actin. Bone density and bone mineralization did not differ significantly between titanium and magnesium (BV/TV: T1: 8.74 ± 2.30%, M1: 6.83 ± 2.89%, p = 0.589 and T2: 71.99 ± 3.13%, M2: 68.58 ± 3.74%, p = 0.394; MinB: T1: 26.16 ± 9.21%, M1: 22.15 ± 7.99%, p = 0.818 and T2: 77.56 ± 3.61%, M2: 79.06 ± 4.46%, p = 0.699). After 12 weeks, minor differences were observed regarding bone microstructure, osteogenic activity, and vascularization. There was significance with regard to bone microstructure (TrTh: T2: 0.08 ± 0.01 mm, M2: 0.06 ± 0.01 mm; p = 0.041). Nevertheless, these differences did not interfere with bone healing. In this study, adequate bone healing was observed in both groups. Only after 12 weeks were some differences detected with larger trabecular spacing and more vessel density in magnesium vs titanium plates. However, a longer observational time with full resorption of the implants should be targeted in future investigations.


Asunto(s)
Placas Óseas , Magnesio , Mandíbula , Titanio , Animales , Magnesio/farmacología , Titanio/química , Titanio/farmacología , Ovinos , Mandíbula/cirugía , Mandíbula/diagnóstico por imagen , Curación de Fractura/efectos de los fármacos , Propiedades de Superficie , Osteogénesis/efectos de los fármacos , Fracturas Mandibulares/cirugía , Fracturas Mandibulares/diagnóstico por imagen , Microtomografía por Rayos X , Aleaciones/química
8.
Acta Biomater ; 185: 98-110, 2024 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-39002920

RESUMEN

Magnesium as a biodegradable material offers promising results in recent studies of different maxillo-facial fracture models. To overcome adverse effects caused by the fast corrosion of pure magnesium in fluid surroundings, various alloys, and surface modifications are tested in animal models. In specified cases, magnesium screws already appeared for clinical use in maxillofacial surgery. The present study aims to compare the bone healing outcome in a non-load-bearing fracture scenario of the forehead in sheep when fixed with standard-sized WE43 magnesium fixation plates and screws with plasma electrolytic oxidation (PEO) surface modification in contrast to titanium osteosynthesis. Surgery was performed on 24 merino mix sheep. The plates and screws were explanted en-bloc with the surrounding tissue after four and twelve weeks. The outcome of bone healing was investigated with micro-computed tomography, histological, immunohistological, and fluorescence analysis. There was no significant difference between groups concerning the bone volume, bone volume/ total volume, and newly formed bone in volumetric and histological analysis at both times of investigation. The fluorescence analysis revealed a significantly lower signal in the magnesium group after one week, although there was no difference in the number of osteoclasts per mm2. The magnesium group had significantly fewer vessels per mm2 in the healing tissue. In conclusion, the non-inferiority of WE43-based magnesium implants with PEO surface modification was verified concerning fracture healing under non-load-bearing conditions in a defect model. STATEMENT OF SIGNIFICANCE: Titanium implants, the current gold standard of fracture fixation, can lead to adverse effects linked to the implant material and often require surgical removal. Therefore, degradable metals like the magnesium alloy WE43 with plasma electrolytic oxidation (PEO) surface modification gained interest. Yet, miniplates of this alloy with PEO surface modification have not been examined in a fracture defect model of the facial skeleton in a large animal model. This study shows, for the first time, the non-inferiority of magnesium miniplates compared to titanium miniplates. In radiological and histological analysis, bone healing was undisturbed. Magnesium miniplates can reduce the number of interventions for implant removal, thus reducing the risk for the patient and minimizing the costs.


Asunto(s)
Placas Óseas , Curación de Fractura , Magnesio , Titanio , Animales , Magnesio/farmacología , Magnesio/química , Titanio/química , Titanio/farmacología , Ovinos , Oxidación-Reducción , Propiedades de Superficie , Tornillos Óseos , Gases em Plasma/farmacología , Gases em Plasma/química , Modelos Animales de Enfermedad , Femenino , Electrólisis
9.
Regen Biomater ; 11: rbae041, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38903563

RESUMEN

Lately, the potential risk of disease transmission due to the use of bovine-derived bone substitutes has become obvious, demonstrating the urgent need for a synthetic grafting material with comparable bioactive behaviour and properties. Therefore, the effect of a synthetic hydroxyapatite (HA) (Osbone®) bone grafting material on bone regeneration was evaluated 2 weeks, 1 month, and 3, 6, 12 and 18 months after implantation in critical-size bone defects in the ovine scapula and compared to that of a bovine-derived HA (Bio-Oss®) and ß-tricalcium phosphate (TCP) (Cerasorb® M). New bone formation and the biodegradability of the bone substitutes were assessed histomorphometrically. Hard tissue histology and immunohistochemical analysis were employed to characterize collagen type I, alkaline phosphatase, osteocalcin, as well as bone sialoprotein expression in the various cell and matrix components of the bone tissue to evaluate the bioactive properties of the bone grafting materials. No inflammatory tissue response was detected with any of the bone substitute materials studied. After 3 and 6 months, ß-TCP (Cerasorb® M) showed superior bone formation when compared to both HA-based materials (3 months: ß-TCP 55.65 ± 2.03% vs. SHA 49.05 ± 3.84% and BHA 47.59 ± 1.97%; p ≤ 0.03; 6 months: ß-TCP 62.03 ± 1.58%; SHA: 55.83 ± 2.59%; BHA: 53.44 ± 0.78%; p ≤ 0.04). Further, after 12 and 18 months, a similar degree of bone formation and bone-particle contact was noted for all three bone substitute materials without any significant differences. The synthetic HA supported new bone formation, osteogenic marker expression, matrix mineralization and good bone-bonding behaviour to an equal and even slightly superior degree compared to the bovine-derived HA. As a result, synthetic HA can be regarded as a valuable alternative to the bovine-derived HA without the potential risk of disease transmission.

10.
Front Oncol ; 14: 1393910, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38774413

RESUMEN

Objective: In advanced oral squamous cell carcinoma (OSCC), adjuvant therapy (AT) is an important part of the treatment to ensure extended locoregional control after primary surgical resection. The impact of the time interval between surgery and AT on the oncological prognosis remains unclear, particularly in high-risk constellations. The aim of this study is to categorize treatment delays and to determine their impact on the oncological prognosis within the context of the histopathological risk parameters of patients with advanced OSCC. Methods: In this single-institutional retrospective cohort study, all patients treated for OSCC between 2016 and 2021 and who received postoperative chemoradiation (POCRT) were included. Patients were divided into two groups: Group I: ≤ 6 weeks between surgery and POCRT; and Group II: > 6 weeks between surgery and POCRT. Results: Overall, 202 patients were included (Group I: 156 (77.2%) vs. Group II: 46 (22.8%)). There were no statistically significant differences in epidemiological aspects and histopathological risk factors between the two groups. The maximum time to initiation of POCRT was 11 weeks. Delayed POCRT initiation had no statistically significant influence on the 5-year OS (61.6% vs. 57.3%, p = 0.89), locoregional control rate (38.6% vs. 43.3%, p = 0.57), and RFS (32.3% vs. 30.4%, p = 0.21). On multivariate analysis, extracapsular spread (HR: 2.21, 95% CI: 1.21 - 4.04, p = 0.01) and incomplete surgical resection (HR: 2.01, 95% CI: 1.10 - 3.69, p = 0.02) were significantly correlated with OS. For RFS, ECS (HR: 1.82, 95% CI: 1.15 - 2.86, p = 0.01), incomplete resection (HR: 1.67, 95% CI: 1.04 - 2.71, p = 0.04), and vascular infiltration of the tumor (V-stage; HR: 2.15, 95% CI: 1.08 - 4.27, p = 0.03) were significant risk predictors. Conclusion: Delays in POCRT initiation up to 11 weeks after surgical resection for advanced OSCC were not statistically significantly associated with impaired survival. In cases of prolonged surgical treatment due to management of complications, a small delay in AT beyond the recommended time limit may be justified and AT should still be pursued.

11.
Sci Rep ; 14(1): 11949, 2024 05 25.
Artículo en Inglés | MEDLINE | ID: mdl-38789467

RESUMEN

Rosacea is often considered a cosmetic problem but is known to be associated with a variety of comorbidities. To identify such risks, we generated two age- and sex-matched real-world cohorts of 122,444 patients each with and without rosacea. In contrast to earlier studies, we found significant associations with malignant melanoma (OR 6.02, 95% CI 5.76-6.32). This association does not exist for an Asian sub-cohort, which could explain previous inconclusive or conflicting reports. Several strongly associated comorbidities like visual disturbances (ICD-10: H53-H54; OR 4.80, 4.68-4.92), metabolic disorders (E73-E79; OR 3.17, 3.11-3.22), joint problems (M25; OR 4.16, 4.08-4.25) and type 2 diabetes (E11; OR 1.62, 1.58-1.65) should be watched as a risk for rosacea patients. Rosacea is associated with some comorbidities and ethnicity may be a risk factor in melanoma development. The retrospective nature of this study and the sole use of ICD-10 code based filtering calls for future validation of our findings. Additionally, confounding factors such as skin type and previous UV exposure should be included in future studies.


Asunto(s)
Melanoma , Rosácea , Población Blanca , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Comorbilidad , Melanoma/epidemiología , Melanoma/etiología , Estudios Retrospectivos , Factores de Riesgo , Rosácea/epidemiología , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/etiología , Pueblo Asiatico
12.
Int J Dermatol ; 2024 Apr 21.
Artículo en Inglés | MEDLINE | ID: mdl-38643367

RESUMEN

BACKGROUND: The role of viral agents in the development of head and neck cancers has remained controversial. While markers of viral origin have been isolated from oral cancer tissues, a causative relationship has yet to be shown. The aim of this study was to evaluate the relationship between head and neck cancers and Herpes simplex virus, one of the most common viral infections of the oral orifice. METHODS: Here, we conducted a retrospective analysis of two age- and gender-matched cohorts extracted from the real-world database TriNetX on March 10th, 2023, each consisting of 249,272 patients with and without Herpes simplex infections (ICD-10: B00). The diagnoses C00-C14 were analyzed, and risk analysis and Kaplan-Meier survival statics were computed. RESULTS: The strongest association was found for lip cancer (ICD-10: C00) with a hazard ratio [HR (CI 95% low-high)] of 3.08 (1.77-5.35). A significant association with HR of 1.17 (1.02-1.34) was found for the entire group of head and neck cancers. Confounders like smoking and alcohol dependence were considered using propensity score matching. CONCLUSION: The surprisingly strong correlation with lip, oral cavity, and pharynx neoplasms sheds new light on supposedly harmless herpes simplex infections, suggesting them as a possible new factor for risk stratification.

13.
Comput Biol Med ; 168: 107817, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38064852

RESUMEN

Titanium patient-specific (CAD/CAM) plates are frequently used in mandibular reconstruction. However, titanium is a very stiff, non-degradable material which also induces artifacts in the imaging. Although magnesium has been proposed as a potential material alternative, the biomechanical conditions in the reconstructed mandible under magnesium CAD/CAM plate fixation are unknown. This study aimed to evaluate the primary fixation stability and potential of magnesium CAD/CAM miniplates. The biomechanical environment in a one segmental mandibular reconstruction with fibula free flap induced by a combination of a short posterior titanium CAD/CAM reconstruction plate and two anterior CAD/CAM miniplates of titanium and/or magnesium was evaluated, using computer modeling approaches. Output parameters were the strains in the healing regions and the stresses in the plates. Mechanical strains increased locally under magnesium fixation. Two plate-protective constellations for magnesium plates were identified: (1) pairing one magnesium miniplate with a parallel titanium miniplate and (2) pairing anterior magnesium miniplates with a posterior titanium reconstruction plate. Due to their degradability and reduced stiffness in comparison to titanium, magnesium plates could be beneficial for bone healing. Magnesium miniplates can be paired with titanium plates to ensure a non-occurrence of plate failure.


Asunto(s)
Colgajos Tisulares Libres , Reconstrucción Mandibular , Humanos , Colgajos Tisulares Libres/cirugía , Reconstrucción Mandibular/métodos , Magnesio , Titanio , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Placas Óseas
14.
Br J Oral Maxillofac Surg ; 62(1): 45-50, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38008679

RESUMEN

Impaired bony healing following bilateral sagittal split osteotomy (BSSO) is a major unmet medical need for affected patients, and rare occurrences can hinder the identification of underlying risk factors. We hypothesised that osseous union following BSSO can be quantified using volumetric analysis, and we aimed to identify the risk factors for impaired bone healing. The percentage change in bony volume was measured in orthognathic patients following BSSO using two consecutive postoperative cone-beam computed tomography scans. Patients' characteristics and treatment parameters were documented, and correlation and regression analyses of these variables performed. Thirty-six patients (23 men and 13 women) with a mean (SD) age of 33.28 (11.86) years were included. The gap site (lingual versus buccal) (p < 0.01) had a significant impact on the change in volume. Age (p = 0.06) showed a trend towards significance. Initial width of the osteotomy gap, sex, and indication for surgery did not influence osseous healing. Increased age at surgery and the side of the buccal osteotomy are independent risk factors for impaired osseous healing following BSSO.


Asunto(s)
Mandíbula , Cirugía Ortognática , Masculino , Humanos , Femenino , Adulto , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Osteotomía Sagital de Rama Mandibular/efectos adversos , Osteotomía Sagital de Rama Mandibular/métodos , Estudios Retrospectivos , Tomografía Computarizada de Haz Cónico/métodos
15.
Head Face Med ; 19(1): 43, 2023 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-37784107

RESUMEN

BACKGROUND: Mechanical and morphological factors have both been described to influence the rate of pseudarthrosis in mandibular reconstruction. By minimizing mechanical confounders, the present study aims to evaluate the impact of bone origin at the intersegmental gap on osseous union. METHODS: Patients were screened retrospectively for undergoing multi-segment fibula free flap reconstruction of the mandible including the anterior part of the mandible and osteosynthesis using patient-specific 3D-printed titanium reconstruction plates. Percentage changes in bone volume and width at the bone interface between the fibula/fibula and fibula/mandible at the anterior intersegmental gaps within the same patient were determined using cone-beam computed tomography (CBCT). Additionally, representative samples of the intersegmental zones were assessed histologically and using micro-computed tomography (µCT). RESULTS: The bone interface (p = 0.223) did not significantly impact the change in bone volume at the intersegmental gap. Radiotherapy (p < 0.001), time between CBCT scans (p = 0.006) and wound healing disorders (p = 0.005) were independent risk factors for osseous non-union. Preliminary analysis of the microstructure of the intersegmental bone did not indicate morphological differences between fibula-fibula and fibula-mandible intersegmental bones. CONCLUSIONS: The bone interface at the intersegmental gap in mandibular reconstruction did not influence long-term bone healing significantly. Mechanical and clinical properties seem to be more relevant for surgical success.


Asunto(s)
Colgajos Tisulares Libres , Neoplasias Mandibulares , Reconstrucción Mandibular , Seudoartrosis , Humanos , Reconstrucción Mandibular/métodos , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/cirugía , Estudios Retrospectivos , Peroné/diagnóstico por imagen , Peroné/cirugía , Seudoartrosis/diagnóstico por imagen , Seudoartrosis/etiología , Seudoartrosis/cirugía , Microtomografía por Rayos X , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Trasplante Óseo/métodos
16.
J Craniomaxillofac Surg ; 51(10): 621-628, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37852889

RESUMEN

This study aimed to compare the clinical outcomes and complication rates of patient-specific 3D-printed mini- and reconstruction plates for free flap fixation in mandibular reconstruction. A retrospective monocentric study was carried out between April 2017 and December 2021 to analyze patients undergoing immediate mandibular reconstruction using fibula free flaps and osteosynthesis using patient-specific 3D-printed implants. Eighty-three patients with a mean age of 63.6 years were included. The mean follow-up period was 18.5 months. Patient-specific 3D-printed plates were designed as reconstruction plates (38 patients), miniplates (21 patients) or a combination of reconstruction- and miniplates (24 patients). With miniplates, plate removal was performed significantly more often via an intraoral approach (p < 0.001) and in an outpatient setting (p = 0.002). Univariate analysis showed a higher fistula rate with reconstruction plates (p = 0.037). Multivariate analysis showed no significant differences in complications. Case-control matching demonstrated significantly lower rates of fistula (p = 0.017) and non-union (p = 0.029) in the combined group. This retrospective study shows a tendency towards reduced complication rates with patient-specific 3D-printed miniplates in comparison to patient-specific 3D-printed reconstruction plates for immediate mandibular reconstruction with fibula free flaps.


Asunto(s)
Fístula , Colgajos Tisulares Libres , Reconstrucción Mandibular , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Mandíbula/cirugía , Placas Óseas , Impresión Tridimensional
17.
Front Bioeng Biotechnol ; 11: 1169385, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37691907

RESUMEN

Introduction: Autologous bone transplantation is successfully used in reconstructive surgery of large/critical-sized bone defects, whereby the microvascular free fibula flap is still regarded as the gold standard for the reconstruction of such defects in the head and neck region. Here, we report the morphological and lacunar properties of patient-paired bone samples from eight patients from the jaw (AB; recipient site) and the fibula (FB; donor site) on the micron length-scale using Synchrotron µ-CT. Insights into differences and similarities between these bone structures could offer a better understanding of the underlying mechanism for successful surgical outcomes and might clear the path for optimized, nature-inspired bone scaffold designs. Methods: Spatial vessel-pore arrangements, bone morphology, fluid-simulation derived permeability tensor, osteocyte lacunar density, and lacunar morphology are compared. Results: The orientation of the vessel system indicates a homogenous vessel orientation for AB and FB. The average mineral distance (50%) to the closest vessel boundary is higher in AB than in FB (the mean is 96 µm for AB vs. 76 µm for FB; p = 0.021). Average osteocyte lacunar density is found to be higher in AB than in FB (mean 22,874 mm3 vs. 19,376 mm3 for FB; p = 0.038), which might compensate for the high distance from the mineral to the nearest vessel. No significant differences in lacunar volume are found between paired AB and FB. Discussion: A comparable vessel network and similar distribution of vessel porosity between AB and FB may allow the FB graft to exhibit a high regeneration potential when connected to AB, and this might correlate with a high osteoinductive and osteoconductive potential of FB when connected to AB. Since widely used and potent synthetic bone grafts exist, new insight into the bone structure of well-established autologous bone grafts, such as the free fibula flap, could help to improve the performance of such materials and therefore the design of 3D scaffolds.

18.
Biomed Eng Online ; 22(1): 84, 2023 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-37641065

RESUMEN

BACKGROUND: The challenges in developing new bone replacement materials and procedures reside not solely in technological innovation and advancement, but also in a broader patient therapy acceptance. Therefore, there is a need to assess patients' perspectives on the materials and approaches in use as well as the ones being developed to better steer future progress in the field. METHODS: A self-initiating cross-sectional questionnaire aimed at people seeking treatment at the university hospital environment of Charité Berlin was formulated. The survey contained 15 close-ended questions directed toward the participant's epidemiological profile, willingness, acceptance, and agreement to receive different bone replacement materials, as well as, worries about the post-surgical consequences that can arise post bone replacement surgery. Descriptive and categorical analysis was performed to compare the observed number of subjects, their profile and each related response (Pearson's chi-square test or Fischer's test, p < 0.05). RESULTS: A total of 198 people engaged with the questionnaire, most of them Millennials. Overall patients trusted scientifically developed biomaterials designed for bone replacement, as demonstrated by their willingness to participate in a clinical trial, their acceptance of alloplastic materials, and the none/few worries about the presence of permanent implants. The data revealed the preferences of patients towards autologous sources of cells and blood to be used with a biomaterial. The data have also shown that both generation and education influenced willingness to participate in a clinical trial and acceptance of alloplastic materials, as well as, worries about the presence of permanent implants and agreement to receive a material with pooled blood and cells. CONCLUSION: Patients were open to the implantation of biomaterials for bone replacement, with a preference toward autologous sources of blood and/or tissue. Moreover, patients are concerned about strategies based on permanent implants, which indicates a need for resorbable materials. The knowledge gained in this study supports the development of new bone biomaterials.


Asunto(s)
Sustitutos de Huesos , Humanos , Estudios Transversales , Materiales Biocompatibles , Hospitales
19.
J Craniomaxillofac Surg ; 51(7-8): 485-489, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37550115

RESUMEN

A comprehensive questionnaire with 43 questions was designed to evaluate quality of life, based on rehabilitation with a facial prosthesis. Each patient's psychological situation was assessed using the validated questionnaire and associated scales. Different patient groups were compared with each other in terms of questionnaire scores and general data. In total, 76 patients with a prosthesis of the orbit, nose, or ear, or a combination thereof, were included. There was a highly significant difference in overall satisfaction with defect reconstruction via a prosthesis of the ear compared with the orbit and nose (F(3) = 6.511, p = 0.001). Patients with congenital defects showed a significantly higher level of general satisfaction compared with patients with acquired defects (F(2) = 5.795, p = 0.001). Patients who returned to work were significantly more satisfied with their quality of life (T(57) = 2.626, p = 0.011). With regard to improvements to the state-of-the-art prostheses, the majority of patients suggested better retention, more durable colors, make-up possibilities, less noticeable margins, softer materials, and a movable orbital prosthesis. Within the limitations of the study it seems that facial epitheses improved mental wellbeing and increased quality of life among patients with facial defects. Multiple factors, such as type of facial defect, location of residence, and education can have a potential influence on the quality of life of affected patients. However, further studies are needed, since the psychological and social challenges remain.


Asunto(s)
Implantes Dentales , Implantes Orbitales , Humanos , Calidad de Vida/psicología , Cara , Nariz/cirugía
20.
Front Bioeng Biotechnol ; 11: 1221314, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37397960

RESUMEN

Introduction: Recently, efforts towards the development of patient-specific 3D printed scaffolds for bone tissue engineering from bioactive ceramics have continuously intensified. For reconstruction of segmental defects after subtotal mandibulectomy a suitable tissue engineered bioceramic bone graft needs to be endowed with homogenously distributed osteoblasts in order to mimic the advantageous features of vascularized autologous fibula grafts, which represent the standard of care, contain osteogenic cells and are transplanted with the respective blood vessel. Consequently, inducing vascularization early on is pivotal for bone tissue engineering. The current study explored an advanced bone tissue engineering approach combining an advanced 3D printing technique for bioactive resorbable ceramic scaffolds with a perfusion cell culture technique for pre-colonization with mesenchymal stem cells, and with an intrinsic angiogenesis technique for regenerating critical size, segmental discontinuity defects in vivo applying a rat model. To this end, the effect of differing Si-CAOP (silica containing calcium alkali orthophosphate) scaffold microarchitecture arising from 3D powder bed printing (RP) or the Schwarzwalder Somers (SSM) replica fabrication technique on vascularization and bone regeneration was analyzed in vivo. In 80 rats 6-mm segmental discontinuity defects were created in the left femur. Methods: Embryonic mesenchymal stem cells were cultured on RP and SSM scaffolds for 7d under perfusion to create Si-CAOP grafts with terminally differentiated osteoblasts and mineralizing bone matrix. These scaffolds were implanted into the segmental defects in combination with an arteriovenous bundle (AVB). Native scaffolds without cells or AVB served as controls. After 3 and 6 months, femurs were processed for angio-µCT or hard tissue histology, histomorphometric and immunohistochemical analysis of angiogenic and osteogenic marker expression. Results: At 3 and 6 months, defects reconstructed with RP scaffolds, cells and AVB displayed a statistically significant higher bone area fraction, blood vessel volume%, blood vessel surface/volume, blood vessel thickness, density and linear density than defects treated with the other scaffold configurations. Discussion: Taken together, this study demonstrated that the AVB technique is well suited for inducing adequate vascularization of the tissue engineered scaffold graft in segmental defects after 3 and 6 months, and that our tissue engineering approach employing 3D powder bed printed scaffolds facilitated segmental defect repair.

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