Mathematical approach improves predictability of length of hospitalisation due to oral squamous cell carcinoma: a retrospective investigation of 153 patients.

Oral squamous cell carcinoma (OSCC), a common cancer of the head and neck, is a major public health problem. The length of stay in hospital (LOS) of patients with OSCC, which can range from a few days to several months, has implications for the patient's recovery. The aim of the study was to identify and evaluate risk factors that have an impact on the prolongation of inpatient hospital stay. A four-year retrospective study reviewed hospital records of 153 inpatients with OSCC. A statistical model for discrete time-to-event data, with the LOS in hospital measured in days for which the event of interest was discharge from hospital, was applied. The model utilises a tree-building algorithm to identify relevant risk factors for a prolonged LOS. Age, type of flap, and occurrence of complications turned out to be relevant variables. Before, and on day 12, the LOS was mainly dependent on flap type and age, whereas after day 12 it was influenced by the presence of early complications. Predicting the likelihood of discharge can improve the management and resource utilisation of the healthcare system among inpatients.

Differences in the Osseous Ultrastructure in 2 Differing Etiologies of Eagle Syndrome. A Micro-CT Study.

OBJECTIVES: Eagle syndrome is a rare disease caused by an elongated styloid process (type I) or ossified stylohyoid ligament (type II) and causes a heterogeneous symptom complex, ranging from pain in the throat and neck to neurological symptoms and neurovascular entrapment. The 2 different types present differing shapes and ultrastructures and cause different symptoms. This study aimed to distinguish the 2 types by investigating the structures by micro-computed tomography. METHODS: Micro-computed tomography was performed and evaluated in n=10 resected styloid processes from patients diagnosed with Eagle syndrome. The tissues were measured for their shape, ratio of soft tissue and bone amounts, bone volume, and ultrastructure, and compared within the groups. RESULTS: The shapes of the different types were different and the ultrastructure differed between the 2 groups, with an absence of trabecular architecture in type II. The area of bone to nonbone tissues in type I samples was significantly higher compared with type II ( P =0.007). Alike these results, the bone volume and bone-to-soft tissue ratio were significantly higher in type I compared with type II ( P =0.009). CONCLUSIONS: The findings suggest that both the popular theories (hyperplasia and metaplasia) may be probable but each solely valid for 1 type of Eagle. Type I may derive from bone hyperplasia with cancellous bone formation and rather high bone density in the elongated styloid process. Type II most likely originates from ligament metaplasia into bone without a compact structure.

Microbiology of Facial Skin Infections-Strains, Susceptibility, and Therapeutic Consequences.

BACKGROUND: Skin and soft tissue infections (SSTIs) are common conditions with severe and potentially life-threatening outcomes. However, the use of antibiotics to treat these infections is controversial. PURPOSE: This study was to identify the microorganisms responsible for facial SSTIs, their antibiotic sensitivities, and the therapeutic outcomes of treatment. STUDY DESIGN, SETTING, AND SAMPLE: This was a retrospective, observational cohort study conducted at a single oral and maxillofacial plastic surgery department. The study sample included 103 patients with facial SSTIs (61 men, 42 women) with a mean age of 41.8 years (standard deviation ± 20.4). PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES: The predictor variables included patient characteristics, antibiotic use before the clinic visit, and the infection's site and origin. MAIN OUTCOME VARIABLE(S): The primary outcome variable was the presence of antibiotic resistance in the bacterial strains isolated from the infections. METHODS: The data were collected by reviewing the results of microbiological swabs and patient records obtained from patients with facial SSTIs. Categorical variables were described using absolute and relative frequencies, and continuous variables were described using mean and standard deviation. The association between antibiotic resistance and the predictor variables was analyzed using Pearson's χ2 test and student's t test. RESULTS: The most common cause of SSTI was an infected epidermal cyst (60.1%). Of all the microorganisms identified, 80.6% were Gram-positive, and 55.8% showed antibiotic resistance against one or more of the evaluated antibiotics, including several backup antibiotics. There were no identified risk factors that significantly influenced the probability of resistance, and there were no adverse events observed. CONCLUSION: The results of this study suggest that surgery should be the primary approach for treating SSTIs, as antibiotic administration may not be effective due to the unknown susceptibility of the causative strains. Antibiotics should be reserved for severe cases and high-risk patients, and if deemed necessary for SSTI management, a broad-spectrum antibiotic should be administered to cover resistant organisms.

Bevacizumab and sunitinib mediate osteogenic and pro-inflammatory molecular changes in primary human alveolar osteoblasts in vitro.

Antiangiogenic medications target the de novo blood vessel formation in tumorigenesis. However, these novel drugs have been linked to the onset of medication-related osteonecrosis of the jaw (MRONJ). The aim of this in vitro study was to examine the effects of the vascular endothelial growth factor A (VEGFA) antibody bevacizumab (BEV) and the receptor tyrosine kinase inhibitor (RTKI) sunitinib (SUN) on primary human osteoblasts derived from the alveolar bone. Primary human alveolar osteoblasts (HAOBs) were treated with BEV or SUN for 48 h. Cellular metabolic activity was examined by XTT assay. Differentially regulated genes were identified by screening of 22 selected osteogenic and angiogenic markers by quantitative real-time reverse transcriptase polymerase chain reaction (qRT2-PCR). Protein levels of alkaline phosphatase (ALP), collagen type 1, α1 (COL1A1) and secreted protein acidic and cysteine rich (SPARC) were examined by enzyme-linked immunoassay (ELISA). Treatment with BEV and SUN did not exhibit direct cytotoxic effects in HAOBs as confirmed by XTT assay. Of the 22 genes examined by qRT2-PCR, four genes were significantly regulated after BEV treatment and eight genes in the SUN group as compared to the control group. Gene expression levels of ALPL, COL1A1 and SPARC were significantly downregulated by both drugs. Further analysis by ELISA indicated the downregulation of protein levels of ALP, COL1A1 and SPARC in the BEV and SUN groups. The effects of BEV and SUN in HAOBs may be mediated by alterations to osteogenic and catabolic markers. Therapeutic or preventive strategies in MRONJ may address drug-induced depression of osteoblast differentiation.

Trismus Due to Hyperplastic Coronoid Process: Series of Five Cases and Review of Literature.

ABSTRACT: Hyperplasia of the coronoid process is a rare condition, potentially leading to a mechanical mouth opening restriction. Diagnostic workup and treatment will be discussed based on 5 cases. This article presents 5 cases of true coronoid process hyperplasia. In addition, we reviewed accessible literature on the topic with special attention to pathophysiologic theories, surgical approach, and postoperative physiotherapy. The improvement in the maximal intercuspidal opening ranged from 4 and 31 mm. Greater maximal intercuspidal opening improvement was connected to compliant patients, while poor outcome occurred in the case of a patient that neither followed the recommendations for physical therapy nor showed up for his follow up appointments. The success of the therapy is defined by a long-lasting and stable improvement of the mouth opening compared to the preoperative situation. In the presented cases, the outcome was strongly dependent on the patients' postoperative compliance. Based on the cases described, we conclude that a good outcome is accomplishable for patients using the methods presented, as long as patients cooperate well after surgery.Diagnostic workup in patients with trismus should be thorough to correctly diagnose rare entities such as coronoid hyperplasia. If treated correctly this condition has a good outcome, as long as the compliance of the patient is adequate.

[Plastic-surgical coverage of an extended defect on the scalp using a bipedicled vascularised flap after removal of two cutaneous squamous epithelial carcinomas]. / Plastische Deckung eines ausgedehnten Defekts nach Entfernung zweier kutaner Plattenepithelkarzinome mittels doppeltem vaskularisierten Brückenlappen am Skalp.

Covering huge scalp defects is often a great challenge. Different aspects play a major role in planing and performing the covering of vast defects. We present the case of a patient with a squamous cell carcinoma of the scalp, measuring 8 × 9 centimeters. After histopathological work-up confirmed the suspected diagnosis and measurements of the carcinom were taken via CT-scan, we operated the patient. The carcinoma already reached into the sinus sagittalis superior. The huge defect was covered by two vascularized bipedicled flaps which were moved into the defect from anterior and posterior. The presented surgical technique appears to be a sufficient way in covering huge defects of the scalp.

Mapping the microbiological diversity of odontogenic abscess: are we using the right drugs?

OBJECTIVES: The aim of this study was categorizing the microbial flora and susceptibility to antibiotics and to clarify to which degree the empiric administered antibiotics are suitable for therapy. MATERIALS AND METHODS: A 3.5-year retrospective study evaluated hospital records of 206 patients who suffered from head and neck infections of odontogenic origin. All patients underwent surgical incision and drainage and received intravenous antibiotics and inpatient treatment. The specimens were obtained by performing a swab. RESULTS: Two hundred six patients were included with 251 strains isolated (1.22 per patient). One hundred eight strains showed antibiotic resistance. Eighty-seven patients showed at least one bacterial strain that showed antibiotic resistance (42.2%). The most frequent isolated bacteria were Streptococcus spp. (n = 116), with a high rate of antibiotic resistance (50.8%). We investigated 205 cases of antibiotic resistance in 87 subjects. Nine bacterial strains showed no susceptibility to unacid (4.3%) and 36 strains to clindamycin (17.5%). CONCLUSION: Antibiotic resistance against clindamycin was rather high. The distribution of the afflicted spaces and isolated bacteria was alike recent findings. It is mandatory to understand that immediate surgical treatment in terms of incision and drainage is the basis in abscess treatment. Antibiotic treatment is adjunct therapy. CLINICAL RELEVANCE: Streptococcus species were the most frequently identified bacteria presenting antibiotic resistance in more than 50%. Increased resistant rates for clindamycin require reconsiderations regarding an empiric antibiotic treatment.

Tree-based modeling of time-varying coefficients in discrete time-to-event models.

Hazard models are popular tools for the modeling of discrete time-to-event data. In particular two approaches for modeling time dependent effects are in common use. The more traditional one assumes a linear predictor with effects of explanatory variables being constant over time. The more flexible approach uses the class of semiparametric models that allow the effects of the explanatory variables to vary smoothly over time. The approach considered here is in between these modeling strategies. It assumes that the effects of the explanatory variables are piecewise constant. It allows, in particular, to evaluate at which time points the effect strength changes and is able to approximate quite complex variations of the change of effects in a simple way. A tree-based method is proposed for modeling the piecewise constant time-varying coefficients, which is embedded into the framework of varying-coefficient models. One important feature of the approach is that it automatically selects the relevant explanatory variables and no separate variable selection procedure is needed. The properties of the method are investigated in several simulation studies and its usefulness is demonstrated by considering two real-world applications.

Antiresorptive drug-related changes of the mandibular bone densitiy in medication-related osteonecrosis of the jaw patients.

OBJECTIVES: Medication-related osteonecrosis of the jaw (MRONJ) is a well known side-effect of anti-resorptive drugs. Changes in bone density might potentially constitute the development of ONJ. This study aimed to investigate, to which degree bisphosphonates (bp) and denosumab (db) induce changes in bone density that can be determined from routine diagnostic CT. METHODS: CT scans of 101 patients were investigated. MRONJ was present in 61 patients (n = 26: db-treated; n = 35 bp-treated). 40 patients were included as a reference group. Bone density was measured at two distinct locations in the mandible (M1: anterior of the mental foramen; M2: retromolar), each on the contralateral side to the necrosis. RESULTS: The bone density values measured at both locations were found to be significantly higher in the bp-group compared to the db-group (p = 0.027) and to the reference-group (p = 0.016). Almost no difference (p = 0.84) in bone density value was found between the db- and reference-groups.Investigating the effect of duration of treatment, none of the measured values showed significant differences in both locations of db- and bp-group. CONCLUSION: The findings from this study suggest that that bisphosphonates change the microarchitecture of the alveolar bone by being embedded in the mandible, which may subsequently lead to a bp-specific corticalization, and a decrease in vascularization of the lower jaw. This process may be distinctive for bp-treatment and seems to induce the congestion of cancellous bone rather rapidly after the first administrations. This effect could not be determined in denosumab-treated patients.

Predictability of pharyngeal airway space dimension changes after orthognathic surgery in class II patients: A mathematical approach.

INTRODUCTION: Angle Class II malocclusion due to mandibular retrognathia is a common dentofacial deformity. It is well known that mandibular advancement increases pharyngeal airway dimensions. The aim of this study was to evolve a mathematical method for predicting posterior pharyngeal airway space (PAS) changes based on 2D lateral cephalographic radiographs (LCRs) and expected extent of mandibular advancement prior to BSSO. MATERIALS AND METHODS: Linear regression analyses were performed in order to investigate the relation between the posterior airway space and mandibular advancement. LCRs where carried out to assess skeletal landmarks and pharyngeal airway space pre- (T0) and postoperatively (T1). To detect changes postoperatively, the posterior airway space was divided into three units: nasopharyngeal airway space (superior airway space - SPAS), oropharyngeal airway space (mid airway space - MAS) and hypopharyngeal airway space (inferior airway space - IAS). The differences between the distances of distinct measurement points (DIFF) were measured pre- and postoperatively. DOA referred to the distance of mandibular advancement and DP to the distance between the measurement points preoperatively. The parameters a, b1 and b2 were the regression coefficients that were determined separately for each unit (SPAS, MAS, and IAS). RESULTS: 49 patients (16 male and 33 female) with a mean age of 27.2 years (SD: 10.09), ranging from 18 to 51 years, who underwent mandibular advancement surgery (BSSO) were enrolled in this study. The mean distance of mandibular advancement was 5.05 mm (SD: 1.63). Regarding SPAS and IAS, mandibular advancement did not affect dimensions significantly: SPAS DIFF, 0.33 mm ± 1.13 mm (b1, p = 0.0881; b2, p = 0.087); IAS DIFF, 0.66 mm ± 2.45 mm (b1, p = 0.342; b2, p = 0.765). DOA and DP did not influence DIFF significantly in both sections. Regarding MAS, the mean effect of mandibular advancement was an expansion of 2.47 mm ± 2.24. The linear regression model showed a statistically significant (b1, p = 0.0064; b2, p = 0.0240) influence of DOA and DP on DIFF in posterior airway dimensions pre- and postoperatively. DISCUSSION: Based on preoperative LCR imaging data, a linear regression model was developed as a mathematical approach to allow prediction of PAS development in patients with Angle Class II malocclusions of different degrees. Increasing mandibular advancement was shown to be linked to increasing PAS, while a greater distance between the measuring points preoperatively led to smaller predicted PAS increases postoperatively. CONCLUSION: Predicting pharyngeal airway space (PAS) development after mandibular advancement by analysing lateral cephalometric radiographs (LCR) may be useful in the screening and treatment of obstructive sleep apnea syndrome (OSAS) patients. Our mathematical approach is a simple and sustainable prediction tool based on LTR data for patients with Class II malocclusions.

The role of immediate versus secondary removal of the odontogenic focus in treatment of deep head and neck space infections. A retrospective analysis of 248 patients.

OBJECTIVES: Aim of this study was to investigate conditions and predisposing factors for head and neck infection progress regarding the length of stay (LOS) in hospital, with special emphasis on the time of removal of the odontogenic infection focus. MATERIAL AND METHODS: A 3-year retrospective study reviewed hospital records of 248 subjects who were treated under inpatient conditions with severe odontogenic infections who received surgical incisions, drainage, and intravenous (IV) antibiotics. Outcomes measured included age, gender, involved fascial spaces, LOS, number of infected spaces, antibiotics administered, and comorbidities. We precisely recorded the time between abscess incision and focus extraction. RESULTS: Removal of infection focus (tooth) in the same stay (1 stay, n = 106; group 1; mean 6.5 days ± 3) showed significantly higher (p = 0.042) LOS than extraction in a second stay (2 stays, n = 46; group 2; 5.3 ± 3.1). Group 3 patients showed infection after removal of teeth in outpatient management (1 stay ex-op, n = 96) and presented significantly lower LOS (5.6 ± 2.5) compared to group 1 (p = 0.0216). LOS of group 3 to group 2 patients showed no significance (p = 0.668). Infection expansion and diabetes showed a significant increase of LOS. CONCLUSION: Simultaneous removal of infection focus and abscess incision leads to the lowest LOS. If tooth extraction is performed after incision, subsequent focus extraction performed in a second stay shows lower overall-LOS than extraction at the same stay at later stage. CLINICAL RELEVANCE: Multiple factors tend to increase the LOS of patients with severe head and neck infections of odontogenic origin. Our data reveals the role of removal of odontogenic focus and additionally ranks further parameters that influence the LOS. Based on our findings, decisions regarding the surgical treatment can be recommended.

A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients.

PURPOSE: Increasing rates of hospitalization of patients diagnosed with acute odontogenic infection have become a burden for public health care, with significant economic concerns. The aim of this study was to investigate factors that tend to prolong hospital length of stay (LOS) in the treatment of severe infections. We present a statistical model that enables the prediction of LOS by exposing the feasibility of the essential statistical determinants. MATERIALS AND METHODS: A 5-year retrospective study investigated records of 303 in-hospital patients with abscess of odontogenic origin. Time-to-event models were used to analyse data where the outcome variable is the time to the occurrence of a specific event. Here, the focus is on a statistical model for the prediction of LOS of patients. RESULTS: The group of all patients (n = 303) was analysed by considering seven characteristics of the patients (age, gender, spreading of infection, localization of infection focus, type of administered antibiotics, diagnosed diabetes mellitus, and existence of a remaining infection focus). Age (p = 0.049; rc = -0.007) and spreading of infection (p < 0.001; rc = -0.965) showed a significant impact on the LOS. Subjects were divided into two groups. Group A (n = 185) consisted of patients who presented with a severe odontogenic infection and not yet removed infection focus; group B were patients having undergone outpatient operative tooth removal (n = 118). To group A patients' data, two new risk factors ("days between abscess incision and removal of infection focus" = dbir and "removal of infection focus during the same stay as abscess incision" = riss) replaced the risk factors "remaining infection focus." A significant impact on the LOS was detected for dbir (p < 0.001; rc = -0.15) and riss (p < 0.001; rc = -1.76). Our statistical model explicitly describes how the probability for discharge depends on the time and how specific characteristics affect the LOS. We observed a significantly higher LOS in older patients and subjects with infection spreading. In group A patients, dbir and riss had a highly significant impact on the LOS. CONCLUSION: Predicting the LOS may promote transparency to costs and management of patients under inpatient treatment. Our statistical model describes the probability of a discharge at time t compared to a discharge later than t (a LOS longer than t). Furthermore, the model enables a prediction of the LOS of each patient for practitioners in an easy way.

The role of C-reactive protein and white blood cell count in the prediction of length of stay in hospital and severity of odontogenic abscess.

INTRODUCTION: Odontogenic infections and subsequent developing abscess remain to be a potentially life-threatening event, due to septicemia, airway compression and spreading into sensitive anatomic tissues. C-reactive proten (CRP) and white blood cell (WBC) count are routinely blood-measured indicators for inflammation. Are CRP-levels and WBC-count predictive factors of the developement of odontogenic abscess? METHODS: A 4-year retrospective study evaluated hospital records of 218 patients, diagnosed and inpatiently treated for acute odontogenic abscess. They received surgical incision, drainage and intravenous antibiotics. CRP-levels and WBC-counts were measured preoperativly. RESULTS: 218 subjects were enrolled in this study. Patients hospitalized 10 days or more showed significantly higher CRP-levels (p = < 0.001) and WBC-counts (p = 0.006) on admission day than patients with lower LOS. CRP-levels of patients with LOS from 7-9 days were significantly lower (p = 0.47) than in people hospitalized 10 days or more. Abscess focus in the mandible shows significantly higher WBC-counts (p = 0.014). Multiple space infections present a significantly higher CRP (p = 0.003) and WBC (p < 0.001) on admission day. DISCUSSION: According to the presented data, CRP-levels and WBC-count can be regarded as predictive factors for LOS (length of stay in hospital) in patients with long term hospitalization (CRP:7-9 days and > 10 days; WBC: > 10 days). Further WBC and CRP are suitable to predict multiple space infections and localisation of the abscess (WBC) in certain limits. CONCLUSION: In predicting the developement of odontogenic abscess, CRP is more capable in providing exact statements regarding the LOS. However, WBC-counts are more suitable in predicting multiple space infections and localization of infection.

The prevalence of pneumatized articular eminence in the temporal bone. Do we need a high resolution computed tomography-based novel risk classification for eminectomy?

INTRODUCTION: Besides mastoid air filled cells, pneumatizations (PN) occasionally occur in the articular eminence (AE) of the temporomandibular joint (TMJ). These findings represent no pathological character but may increase the risk of perforating the AE during eminectomy with potential harming the skull base. Various classifications catagorize the degree of temporal PN without focussing solely on the AE. Panoramic radiograph (PR) and computed tomographie (CT) are both described as suitable for diagnosing PNs. Are the common ways of imaging capable for precise diagnosis and do we need a risk pattern for eminectomy? METHODS: A 4-year retrospective study evaluated high resolution computed tomographie (HRCTs) of 300 patients. We screened digitalized skull images for PN of the AE. The frankfort horizontal was determined as the reference mark for measurements. Images were assessed by a craniomaxillofacial surgeon and a radiologist. RESULTS: 300 patients (600 AEs) were investigated. We detected 60 PNs (10% of all AEs) in 44 patients (14.7%). We subdevided the findings according to the extent of PN. 10 AEs showed PNs of less than 20% (type 1); n=18: 21-40% (type 2); n=18: 41-70% (type 3). n=14: 71 to 100% (type 4). In 32 cases (72.7%) with 42 PNs a PR existed. Of the 42 AEs, corresponding PN could be detected in 21 cases (50%). DISCUSSION: PNs are a potential threat when performing TMJ surgery. Sufficient preoperative imaging is required to avoid severe endangerment for the patient. CT imaging is most suitable detecting PNs. PR seem to fail in diagnosing PNs of different degree. Our novel HRCT-based classification shows the distribution of PNs and provides a risk pattern. CONCLUSION: HRCT exceeds the diagnostic accuracy of PR in detecting pneumatized AEs. PR is not capable for detecting PNs of different degree. A novel classification may increase the prediction of perforation risk. Restricting eminectomy to reduce height only to a certain amount reduces the risk of complications.

Fibrous dysplasia imitating malignancy.

Fibrous dysplasia is a benign bone disease, presenting as monostotic or polyostotic lesions, or as part of a syndrome (McCune-Albright/Mazabraud). Its clinical course shows a variegated picture and the progression of its growth is unpredictable. In the workup of 39 fibrous dysplasia cases in the cranio-facial area, four cases presented fast growth tendencies, of which two patients with McCune-Albright syndrome showed malignant-like rapid growth. This local aggressive form is extremely rare, and the concept of this issue has not been clearly defined. With regard to the speed of growth a volumetric-time analysis in one of our cases demonstrated a 74 days tumor doubling rate with an exponential growth curve. According to the literature the aggressive form presented extra-cranially mainly at an adult age, whereas its appearance in our cranio-facial patient collective was much younger. Distinguishing nonmalignant and malignant aggressive forms is difficult and highly inconsistent in the literature. We therefore implemented a quantitative growth measure analysis to define aggressive forms based on progression and speed of growth and impartial of type of FD, localization or functional incapacity. Due to our study findings and literature review we state a prevalence of an aggressive form might be possibly about 5 %.

Head circumference - a useful single parameter for skull volume development in cranial growth analysis?

BACKGROUND: The measurement of maximal head circumference is a standard procedure in the examination of childrens' cranial growth and brain development. The objective of the study was to evaluate the validity of maximal head circumference to cranial volume in the first year of life using a new method which includes ear-to-ear over the head distance and maximal cranial length measurement. METHODS: 3D surface scans for cranial volume assessment were conducted in this method comparison study of 44 healthy Caucasian children (29 male, 15 female) at the ages of 4 and 12 months. RESULTS: Cranial volume increased from measurements made at 4 months to 12 months of age by an average of 1174 ± 106 to 1579 ± 79 ml. Maximal cranial circumference increased from 43.4 ± 9 cm to 46.9 ± 7 cm and the ear-to ear measurement increased from 26.3 ± 21 cm to 31.6 ± 18 cm at the same time points. There was a monotone association between maximal head circumference (HC) and increase in volume, yet a backwards inference from maximal circumference to the volume had a predictive value of only 78% (adjusted R2). Including the additional measurement of distance from ear to ear strengthened the ability of the model to predict the true value attained to 90%. The addition of the parameter skull length appeared to be negligible. CONCLUSION: The results demonstrate that for a distinct improvement in the evaluation of a physiological cranial volume development, the additional measurement of the ear-to ear distance using a measuring tape is expedient, and, especially for cases with pathological skull changes, such as craniosynostosis, ought to be conducted.

Vitamin D (25-OHD) deficiency may increase the prevalence of medication-related osteonecrosis of the jaw.

INTRODUCTION: Osteonecrosis of the jaw (ONJ) is a severe complication of antiresorptive medication (AM) in the treatment of bone-affecting cancer-related conditions and osteoporosis. Aim of this study was to reveal whether patients treated with AM and show Medication Related OsteoNecrosis of the Jaw (MRONJ) are vitamin D deficient or not. MATERIALS AND METHODS: A 2 year retrospective study evaluated hospital records of 63 patients who received AM. Patients were divided into two groups. One group (n = 45) consisted of patients who presented a stage 2 ONJ (eb+ = exposed bone). Second group patients (n = 18) (eb- = no exposed bone) presented for extraction of teeth. Serum levels of vitamin D (25-OHD) were analysed. P values ≤ 0.05 in t-test were regarded as statistically significant. RESULTS: Serum levels of 25-OHD were significantly higher in the eb(-) group (29.5 ng/ml), than in the eb(+) group (20.49 ng/ml). Blood levels of calcium were also significantly higher in eb(-) group (2.25 mmol/L; 0.11 SD) than in eb(+) group (2.175 mmol/L; 0.16 SD). CONCLUSION: Prevalence of MRONJ in AM treated patients seems to be increased by low serum 25-OHD. A measurable tendency in the role of 25-OHD for the development of MRONJ was recorded and leads to the recommendation for a sufficient vitamin D substitution in patients treated with AM.

Bite force and electromyography evaluation after cranioplasty in patients with craniosynostosis.

OBJECTIVE: This long-term follow-up investigation aimed to assess masticatory muscle function in 15 patients with craniosynostosis with detachment of the temporal muscle during fronto-orbital advancement 6 years after cranioplasty compared with a non-operative stomatognathic healthy cohort in the same age group (n = 25). STUDY DESIGN: The follow-up assessment for the operated children occurred on average 5.2 ± 1.7 years after surgery at the age of 7 ± 1.6 years. The maximum bite force was assessed, in addition to the bilateral function of both temporal and masseter muscles, which were analyzed using superficial electromyography. RESULTS: The maximum bite force was 257 ± 89 N 255 ± 88 N (right/left), respectively, in the group of operated children and 212 ± 61 N and 203 ± 57 N (right/left), respectively, in the control group, without clinical relevant difference between groups. The surface electromyography signal of the temporal muscle correlated positively with the bite force and showed a slightly lower average resting tone activity in the control group, whereas muscle fatigue occurred slightly faster in the operated children in both muscles without statistically significant difference between the 2 groups. CONCLUSIONS: There was no measurable dysfunction in the temporal muscle after the operative correction of craniosynostosis compared with a healthy population of children.

Microbiology and antibiotic sensitivity of head and neck space infections of odontogenic origin. Differences in inpatient and outpatient management.

INTRODUCTION: The microbial flora of infections of the orofacial region of odontogenic origin is typically polymicrobial. Shortly after mass production of the first antibiotics, antibiotic resistant microorganisms were observed. METHODS: A 28-months retrospective study evaluated hospital records of 107 patients that were treated for head and neck infections of odontogenic origin. All patients underwent surgical incision and drainage. RESULTS: There were 65 male (61%) and 42 female (39%) patients ranging in age from 5 to 91 years, with a mean age of 48 years (SD = 21). 52 patients underwent outpatient management and 55 patients inpatient management. A total of 92 bacterial strains were isolated from 107 patients, accounting for 0.86 isolates per patient. Overall 46 bacterial strains were isolated from patients that underwent outpatient and 34 bacterial strains that underwent inpatient treatment. 32.6% of the strains, isolated from outpatient treated individuals showed resistances against one or more of the tested antibiotics. Isolated strains of inpatient treated individuals showed resistances in 52.9%. DISCUSSION: According to this study's data, penicillin continues to be a highly effective antibiotic to be used against viridans streptococci, group C Streptococci and prevotella, whereas clindamycin was not shown to be effective as an empirical drug of choice for most odontogenic infections. CONCLUSION: Microorganisms that show low susceptibility to one or more of the standard antibiotic therapy regimes have a significantly higher chance of causing serious health problems, a tendency of spreading and are more likely to require an inpatient management with admission of IV antibiotics. Penicillin continues to be a highly effective antibiotic to be used against viridans streptococci, group C Streptococci and prevotella, whereas clindamycin could not be shown to be effective as an empirical drug of choice for a high number of odontogenic infections.

Eagle Syndrome: a Follow-Up Examination of Four Patients After Surgical Treatment Via Cervical Approach.

OBJECTIVE: Eagle syndrome is a rare pain syndrome caused by an elongated styloid apophysis or an ossified styloid ligament. It is characterized by a complex range of symptoms in head and neck region. The most effective treatment is surgical shortening of the styloid apophysis. The authors report of a follow-up examination of 4 patients after surgical treatment via cervical approach. METHODS: Retrospectively reviewed hospital records of 5 patients (4 females and 1 male), aged from 26 to 59 years old (mean age = 45.5 years) who underwent surgical shortening of the styloid process via cervical approach. Further, a paper-based survey of 4 patients was conducted, including a clinical questionnaire and 4 visual analogue scales, consisting of questions regarding postoperative pain. RESULTS: Period of follow-up ranged from 16 to 79 months (mean 53.75 months). All patients were asymptomatic at follow-up. None of the patients reported a visible scar or hypoesthesia in the affected area. The patients demonstrated low mean visual analogue scales for each item (facial pain: 0.6 ±â€Š1.2, foreign body sensation: 0.725 ±â€Š1.45, pain of throat and neck 1.35 ±â€Š1.58 and limitation of dietary habits: 0.75 ±â€Š1.5). None of the patients reported a resurgence of pain in the head and neck region so far. CONCLUSIONS: Surgical treatment via cervical approach appears to be an effective and safe option with low morbidity and mortality in the treatment of symptomatic Eagle syndrome of adults.