Prosthetic reconstruction of a patient with an irradiated total rhinectomy with navigated surgical placement of a single zygomatic implant: A clinical report.

This clinical report details the rehabilitation of a patient who underwent a total rhinectomy, subsequent adjuvant radiation therapy, and eventual prosthetic rehabilitation but then developed an empirically diagnosed medical adhesive intolerance. With the aid of digital planning and real time navigation, 2 zygomatic implants were placed by using a flapless surgical approach followed by early delivery of an interim prosthesis. In spite of the failure of 1 craniofacial implant, definitive restoration was accomplished by using a titanium bar, double magnetic attachments, and a new silicone prosthesis.

Prevalence of comorbid obstructive sleep apnea and metabolic syndrome: syndrome Z and maxillofacial surgery implications.

PURPOSE: To determine the prevalence of the recently identified syndrome Z (SZ), which is the co-occurrence of obstructive sleep apnea (OSA; hypoxia, systemic and pulmonary hypertension, nocturnal arrhythmias) and metabolic syndrome (MetS; increased abdominal girth, hypertriglyceridemia, decreased high-density lipoprotein, hypertension, increased fasting glucose), which places the surgical patient at heightened risk of perioperative complications (myocardial infarction, stroke, pneumonia, wound infection). MATERIALS AND METHODS: Electronic medical records of 296 male veterans were assessed for the presence of SZ using the American Academy of Sleep Medicine definition of OSA and a modified Adult Treatment Panel III definition of MetS, where obesity was defined by a body mass index of at least 30 kg/m(2) rather than by waist circumference. RESULTS: SZ was diagnosed in 59% of patients. These individuals commonly exhibited severe OSA and least commonly mild OSA. The more severe the OSA, the more likely (60%) that patients manifested moderate (4 risk markers) or severe (5 risk markers) MetS. Furthermore, with increasing apnea-hypopnea index values, the more severe were the MetS elements. CONCLUSIONS: The results of this study demonstrate the high prevalence rate of MetS in patients with OSA seeking treatment. Given the risk of perioperative complications, it is suggested that all patients scheduled for maxillofacial surgical procedures to treat OSA be evaluated for SZ.

Quasi-experimental study designs series-paper 7: assessing the assumptions.

Quasi-experimental designs are gaining popularity in epidemiology and health systems research-in particular for the evaluation of health care practice, programs, and policy-because they allow strong causal inferences without randomized controlled experiments. We describe the concepts underlying five important quasi-experimental designs: Instrumental Variables, Regression Discontinuity, Interrupted Time Series, Fixed Effects, and Difference-in-Differences designs. We illustrate each of the designs with an example from health research. We then describe the assumptions required for each of the designs to ensure valid causal inference and discuss the tests available to examine the assumptions.

Prevalence of calcified carotid artery atheromas on the panoramic images of patients with syndrome Z, coexisting obstructive sleep apnea, and metabolic syndrome.

OBJECTIVES: The objective of this study was to compare the prevalence of calcified carotid artery atheromas (CCAAs) on panoramic images of individuals (n = 31) with obstructive sleep apnea (OSA) with individuals (n = 117) with syndrome Z (SZ: OSA with concomitant metabolic syndrome [MetS]). STUDY DESIGN: Images of patients with OSA or SZ referred from the Sleep Service to Dentistry were evaluated. Descriptive statistics and t tests (Bonferroni correction) were conducted to determine significant differences between atheroma prevalence and proatherogenic factors (age, apnea-hypopnea index, body mass index, lipid profile, blood pressure, glucose) between OSA and SZ groups. RESULTS: Individuals with OSA had an atheroma prevalence of 35% and those with SZ 42% (P = .52). Individuals with SZ also had significantly more severe atherogenic profiles (obesity, dyslipidemia, hyperglycemia) than OSA patients (P ≤ .05). Greatest CCAA prevalence (63%) was evidenced by SZ patients with severe OSA and moderate MetS. CONCLUSION: Individuals with SZ have significantly greater atherogenic burden and slightly higher prevalence of CCAAs when compared with individuals with OSA.