Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 14 de 14
Filtrar
1.
Oral Maxillofac Surg ; 28(4): 1501-1507, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38918316

RESUMO

OBJECTIVES: The purpose of this study was to compare two different designs of three-dimensional osteosynthesis plates for their suitability in the treatment of mandibular angle fractures in terms of sufficient fracture healing and concomitant complications. MATERIALS AND METHODS: Retrospectively a total of 54 patients with 56 mandibular angle fractures were evaluated. Two different types of three-dimensional plates from the Medartis Trilock system were analyzed: (A) Square design plate (☐-plate) with a thickness of 1.0 mm, and (B) triangular-shaped 3D-plate (△-plate) with a thickness of 1.3 mm. Patient demographics, fracture mechanism and intraoperative details were recorded during an average follow-up period of 1 year. RESULTS: The utilization of △-plates was observed to entail a considerably lengthier surgical time in contrast to ☐-plate systems (P = 0.037). The application of △-plate showed a tendency of higher incidence of major complications than ☐-plate (P = 0.06), as evidenced by the occurrence of non-union in 2 out of 22 cases, resulting in higher surgical revision rate for △-plate (P = 0.027). CONCLUSION: Sufficient treatment of mandibular angle fractures is feasible by using 1.0 mm thick, square shaped three-dimensional plate systems. The use of thicker three-dimensional osteosynthesis plates seems to significantly increase the operating time and complication rates, whereby the geometry of the plate seems to have an influence. CLINICAL RELEVANCE: The plate design could have an impact on treatment outcomes of mandibular angle fractures. TRIAL REGISTRATION NUMBER: Not applicable.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Fraturas Mandibulares , Humanos , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares/diagnóstico por imagem , Estudos Retrospectivos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Idoso , Consolidação da Fratura/fisiologia , Adulto Jovem , Adolescente , Resultado do Tratamento , Duração da Cirurgia
2.
J Craniofac Surg ; 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38781423

RESUMO

The authors present a novel approach for addressing excessive condylar growth in individuals exhibiting asymmetric mandibular growth patterns.

3.
J Clin Med ; 12(24)2023 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-38137822

RESUMO

BACKGROUND: In head and neck reconstructive surgery, postoperative complications are a well-known concern. METHODS: We examined 46 patients who underwent ablative surgery and received fibula free flap reconstruction. The main focus was to assess the influence of intraoperative blood pressure fluctuations and the administration of inotropic drugs on complications, either related to the flap or systemic, serving as the primary endpoint. RESULTS: Utilizing logistic regression models, we identified that intraoperative mean arterial blood pressure (MAP) drops did not correlate with the occurrence of either flap-related complications (MAP < 70, p = 0.79; MAP < 65, p = 0.865; MAP < 60, p = 0.803; MAP < 55, p = 0.937) or systemic medical complications (MAP < 70, p = 0.559; MAP < 65, p = 0.396; MAP < 60, p = 0.211; MAP < 55, p = 0.936). The occurrence of flap-related complications significantly increased if a higher dosage of dobutamine was administered (median 27.5 (IQR 0-47.5) vs. 62 (38-109) mg, p = 0.019) but not if norepinephrine was administered (p = 0.493). This correlation was especially noticeable given the uptick in complications associated with fluid overload (3692 (3101-4388) vs. 4859 (3555-6216) mL, p = 0.026). CONCLUSION: Intraoperative and immediate postoperative blood pressure fluctuations are common but are not directly associated with flap-related complications; however, dobutamine application as well as fluid overload may impact flap-specific complications.

4.
J Clin Med ; 12(11)2023 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-37297852

RESUMO

The aim of this study was to evaluate the feasibility of opioid-free anesthesia (OFA) in open radical cystectomy (ORC) with urinary diversion and to assess the impact on recovery of gastrointestinal function. We hypothesized that OFA would lead to earlier recovery of bowel function. A total of 44 patients who underwent standardized ORC were divided into two groups (OFA group vs. control group). In both groups, patients received epidural analgesia (OFA group: bupivacaine 0.25%, control group: bupivacaine 0.1%, fentanyl 2 mcg/mL, and epinephrine 2 mcg/mL). The primary endpoint was time to first defecation. Secondary endpoints were incidence of postoperative ileus (POI) and incidence of postoperative nausea and vomiting (PONV). The median time to first defecation was 62.5 h [45.8-80.8] in the OFA group and 118.5 h [82.6-142.3] (p < 0.001) in the control group. With regard to POI (OFA group: 1/22 patients (4.5%); control group: 2/22 (9.1%)) and PONV (OFA group: 5/22 patients (22.7%); control group: 10/22 (45.5%)), trends but no significant results were found (p = 0.99 and p = 0.203, respectively). OFA appears to be feasible in ORC and to improve postoperative functional gastrointestinal recovery by halving the time to first defecation compared with standard fentanyl-based intraoperative anesthesia.

5.
Artigo em Inglês | MEDLINE | ID: mdl-36901244

RESUMO

E-scooters have gained popularity worldwide in the last few years. Due to the increase in users, more accidents related to e-scooters can be observed. The present study aimed to analyse epidemiological data, characteristics, and severity of injuries in patients admitted to a Level I trauma centre in Switzerland (Inselspital Bern, University Hospital Bern) after accidents associated with e-scooters. This retrospective case series evaluated 23 patients who presented to the University Hospital of Bern between 1 of May 2019 and 31 of October 2021 after an e-scooter accident. Data were collected on patient demographics, time and cause of the accident, speed, alcohol consumption, helmet use, type and localisation of injury, number of injuries per patient, and outcome. Men were most frequently affected (61.9%). The mean age was 35.8 (STD 14.8) years. Slightly more than half (52.2%) of all accidents were self-inflicted. Most accidents were reported during the night (7 p.m. to 7 a.m., 60.9%) and in summer (43.5%). Alcohol consumption was reported in 43.5% of cases, with a mean blood alcohol level of 1.4 g/l. Most injuries were observed in the face (25.3%) and head/neck area (20.25%). Skin abrasions (56.5%) and traumatic brain injury (43.5%) were the most common types of traumata in terms of total number of patients. Only in one case it was reported that a protective helmet had been worn. Five patients required hospitalisation and four patients underwent surgery. Three patients underwent emergency orthopaedic surgery, and one patient underwent emergency neurosurgery. E-scooter accidents result in a significant number of facial and head/neck injuries. E-scooter riders would potentially benefit from a helmet to protect them in the event of an accident. Additionally, the results of this study indicate that a significant number of e-scooter accidents in Switzerland occurred under the influence of alcohol. Prevention campaigns to raise awareness of the risks of driving e-scooters under the influence of alcohol could help prevent future accidents.


Assuntos
Acidentes , Consumo de Bebidas Alcoólicas , Masculino , Humanos , Adulto , Estudos Retrospectivos , Suíça , Centros de Traumatologia
6.
Front Surg ; 8: 771282, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34970591

RESUMO

Postoperative complications in head and neck surgery are well-known, but a predictive model to guide clinicians in free flap reconstructions has not been established. This retrospective single-center observational study assessed 131 patients who underwent ablative surgery and received free flap reconstruction. Primary endpoint was the occurrence of systemic complications (PSC). Secondary endpoint was the generation of a nomogram of complications according to the CDC classification. In the ordinal regression model, postoperative administration of furosemide [1.36 (0.63-2.11), p < 0.0001], blood loss [0.001 (0.0004-0.0020), p = 0.004], postoperative nadir hemoglobin [-0.03 (-0.07-0.01), p = 0.108], smoking [0.72 (0.02-1.44), p = 0.043], and type of flap reconstruction [1.01 (0.21-1.84), p = 0.014] as predictors. A nomogram with acceptable discrimination was proposed (Somer's delta: 0.52). Application of this nomogram in clinical practice could help identify potentially modifiable risk factors and thus reduce the incidence of postoperative complications in patients undergoing microvascular reconstruction of the head and neck.

7.
Swiss Dent J ; 131(9): 713-718, 2021 Sep 06.
Artigo em Alemão | MEDLINE | ID: mdl-34472712

RESUMO

Osteoradionecrosis (ORN) is a serious complication after radiotherapy for head and neck cancer and is a challenging condition for both the therapist and the patient because of its difficult treatment. Different non-invasive approaches have been published for the treatment of low-grade ORN cases without establishing a standard regimen for treatment. Based on the approach of ORN pathogenesis, the so-called radiatio-induced fibroathrophic process (RIF), a new treatment concept with pentoxifylline and tocopherol (PENTO) has been published. The results of PENTO therapy seem promising as a conservative treatment approach for mild ORN or as an alternative when surgical intervention is not possible or desired. The present study summarizes the current state of the literature and shows the effectiveness of PENTO therapy based on a case report.


Assuntos
Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Pentoxifilina , Humanos , Osteorradionecrose/tratamento farmacológico , Pentoxifilina/uso terapêutico , Tocoferóis/uso terapêutico
8.
Clin Oral Investig ; 25(10): 5579-5593, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34401944

RESUMO

OBJECTIVES: This systematic review assesses dental implant survival, calculates the incidence rate of osteoradionecrosis, and evaluates risk factors in irradiated head and neck cancer patients. MATERIALS AND METHODS: Various databases (e.g., Medline/Embase using Ovid) and gray literature platforms were searched using a combination of keywords and subject headings. When appropriate, meta-analysis was carried out using a random effects model. Otherwise, pooled analysis was applied. RESULTS: A total of 425 of the 660 included patients received radiotherapy. In total, 2602 dental implants were placed, and 1637 were placed in irradiated patients. Implant survival after an average follow-up of 37.7 months was 97% (5% confidence interval, CI 95.2%, 95% CI 98.3%) in nonirradiated patients and 91.9% (5% CI 87.7%, 95% CI: 95.3%) after an average follow-up of 39.8 months in irradiated patients. Osteoradionecrosis occurred in 11 cases, leading to an incidence of 3% (5% CI 1.6%, 95% CI 4.9%). The main factors impacting implant survival were radiation and grafting status, while factors influencing osteoradionecrosis could not be determined using meta-analysis. CONCLUSION: Our data show that implant survival in irradiated patients is lower than in nonirradiated patients, and osteoradionecrosis is-while rare-a serious complication that any OMF surgeon should be prepared for. The key to success could be a standardized patient selection and therapy to improve the standard of care, reduce risks and shorten treatment time. CLINICAL RELEVANCE: Our analysis provides further evidence that implant placement is a feasible treatment option in irradiated head and neck cancer patients with diminished oral function and good long-term cancer prognosis.


Assuntos
Implantes Dentários , Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Implantação Dentária Endóssea , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Osteorradionecrose/etiologia
9.
Clin Oral Investig ; 25(9): 5541-5550, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33686470

RESUMO

OBJECTIVES: The aim of this study was to determine the influence of perioperative fluid management and administration of vasopressors on early surgical revision and flap-related complications in free tissue transfer. MATERIALS AND METHODS: Intraoperative amount of fluid and of vasopressors, relevant perioperative parameters, and comorbidities were recorded in 131 patients undergoing head and neck microvascular reconstruction and compared with early surgical complications, defined as interventions requiring surgery after a flap-related complication, and/or other surgical problems in the operating room within 30 days after initial surgery. The relationship between perioperative variables for each revision category was determined using an optimized multiple logistic regression. RESULTS: The administration of diuretics (p=0.001) as a treatment for perioperative fluid overload and the type of flap (p=0.019) was associated with a higher risk of early surgical revisions. Perioperative fluid overload (p=0.039) is significantly related to flap-related complications. We found no effect of intraoperative administration of vasopressors on early surgical revisions (p=0.8) or on flap-related complications (norepinephrine p=0.6, dobutamine p=0.5). CONCLUSION: Perioperative fluid overload is associated with higher risks of early surgical revision and flap-related complications. In contrast, the administration of vasopressors seemed to have no effect on either surgical revision rate or flap-related complications. CLINICAL RELEVANCE: In patients receiving microvascular reconstructions, a balanced fluid administration perioperatively and a targeted use of vasopressors should be the necessary strategy to reduce the complication rates in head and neck surgery.


Assuntos
Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço , Procedimentos de Cirurgia Plástica , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Complicações Pós-Operatórias/epidemiologia , Reoperação , Estudos Retrospectivos
10.
J Craniomaxillofac Surg ; 48(8): 756-764, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32611510

RESUMO

PURPOSE: The aim of this study was to examine two different types of three-dimensional plate for their suitability for the treatment of condylar neck and base fractures, and to evaluate the most frequent complications, while considering three different surgical approaches. MATERIALS AND METHODS: This retrospective study was conducted in patients who received two different types of three-dimensional plate for the treatment of condylar neck and base fractures, using three different surgical approaches, from January 2016 to December 2018. Medical records were obtained during an average follow-up period of 9 months after the traumatic event, with data collected on factors affecting success and failure of miniplates, clinical outcome parameters, and complications. RESULTS: A total of 43 fractures (38 patients) were examined. No differences were found between the two plate designs (mean = 0.093, SD = 0.294, p = 0.562). All fractures achieved complete bone healing, but in four cases, a revision operation had to be performed. No significant complications were found regardless of the surgical approaches chosen. There was no correlation between plate system (mean = 0.419, SD = 0.492, p = 0.497) or surgical access (mean = 0.163, SD = 0.432, p = 0.247) and the occurrence of facial nerve palsy found. Due to the extraoral approach used, permanent facial nerve palsy was reported in one case. With the intraoral approach, one case of transient facial paresis was observed. No facial palsy was observed in patients treated via a preauricular approach. CONCLUSION: Deltoid and trapezoid plates seem to perform equally in the treatment of condylar neck and base fractures.


Assuntos
Fraturas Mandibulares , Placas Ósseas , Fixação Interna de Fraturas , Humanos , Côndilo Mandibular , Estudos Retrospectivos , Titânio , Resultado do Tratamento
11.
Case Rep Emerg Med ; 2019: 6208604, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31781415

RESUMO

BACKGROUND: The number of patients receiving direct oral anticoagulants (DOACs) is increasing, however, this treatment is associated with the risk of bleeding. More than 10 percent of patients on DOACs have to interrupt their anticoagulation for an invasive procedure every year. For this reason, the correct management of DOACs in the perioperative setting is mandatory. CASE PRESENTATION: An 81-year-old male patient, with known impaired renal function, presented to our emergency department with a severe enoral bleeding after tooth extraction. The DOAC therapy-indicated by known atrial fibrillation-was interrupted perioperatively and bridged with Low Molecular Weight Heparin (LMWH). The acute bleeding was stopped by local surgery. The factors contributing to the bleeding complication were bridging of DOAC treatment, together with prolonged drug action in chronic kidney disease. CONCLUSION: In order to decide whether it is necessary to stop DOAC medication for tooth extraction, it is important to carefully weigh up the individual risks of bleeding and thrombosis. If DOAC therapy is interrupted, bridging should be reserved for thromboembolic high-risk situations. Particular caution is required in patients with impaired kidney function, due to the risk of accumulation and prolonged anticoagulant effect of both DOACs and LMWH.

12.
Gerodontology ; 36(4): 358-364, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31274224

RESUMO

OBJECTIVE: To assess the prevalence and surgical treatment of facial fractures in a Swiss population aged 65 and over. BACKGROUND: The knowledge of the characteristics of geriatric trauma may help to prevent injuries and better allocate clinical resources for the management of multimorbid patients. MATERIAL AND METHODS: This study retrospectively evaluated a cohort of 181 patients who presented at the Bern University Hospital in Switzerland from May 2012 to September 2016. Data on age, gender, aetiology and type of trauma, treatment and complications, co-morbidities and associated injuries were obtained. RESULTS: Women were most frequently affected (55.2%). Mean age was 80 years. Zygomatic complex fractures were the most frequent type of fractures (37%), followed by isolated orbital fractures (27.6%). Falls were the most common cause of trauma (76.1%). Thirty-five per cent of all patients were taking anticoagulation or platelet aggregation medication. Hospitalisation was required in 88.4%, whereby 92.3% of the patients underwent surgical treatment. Surgery had to be performed immediately in three cases to treat compression of the optic nerve. Median hospital length of stay was 4 days, with 68% of patients returning to a domestic environment and 32% being transferred to another institution for further treatment. CONCLUSION: The most common cause of facial injuries is a fall while standing in a domestic environment. Midface fractures were the most common type of fractures.


Assuntos
Traumatismos Faciais , Fraturas Cranianas , Fraturas Zigomáticas , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Retrospectivos
13.
J Oral Maxillofac Surg ; 76(10): 2138-2150, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29684308

RESUMO

PURPOSE: This study compared the degradation profile, safety, and efficacy of bioresorbable magnesium alloy and polylactide-co-glycolide (PLGA) polymer osteosynthesis systems for the treatment of fractures in a load-sharing maxillofacial environment using a new mini-swine fracture fixation model. MATERIALS AND METHODS: Two types of clinically relevant situations were evaluated in 5 Yucatan miniature pigs. Defined porcine midface osteotomies of the supraorbital rim and zygoma were created and fixed with either a coated magnesium (test animals) or PLGA plate and screw osteosynthesis system (control animals). After surgery, the mini-pigs were able to recover for either 1 or 9 months with continuous in vivo post-implantation monitoring. Standardized computed tomography (CT) imaging was taken immediately postoperatively and at termination for all animals. The 9-month cohort also underwent CT at 2, 4, and 6 months after surgery. At necropsy, osteotomy sites and bone-implant units were harvested, and healing was evaluated by micro-CT, histopathology, and histomorphometry. RESULTS: After clinical and radiologic follow-up examination, all fracture sites healed well for both the magnesium and polymer groups regardless of time point. Complete bone union and gradually disappearing osteotomy lines were observed across all implantation sites, with no major consistency change in periprosthetic soft tissue or in soft tissue calcification. Macroscopic and microscopic examination showed no negative influence of gas formation observed with magnesium during the healing process. Histopathologic analysis showed similar fracture healing outcomes for both plating systems with good biocompatibility as evidenced by a minimal or mild tissue reaction. CONCLUSIONS: This study confirms that WE43 magnesium alloy exhibited excellent fracture healing properties before its full degradation without causing any substantial inflammatory reactions in a long-term porcine model. Compared with PLGA implants, magnesium represents a promising new biomaterial with reduced implant sizes and improved mechanical properties to support fracture healing in a load-sharing environment.


Assuntos
Placas Ósseas , Remodelação Óssea/fisiologia , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Osteotomia/métodos , Tomografia Computadorizada por Raios X/métodos , Zigoma/diagnóstico por imagem , Zigoma/cirurgia , Implantes Absorvíveis , Ligas , Animais , Materiais Biocompatíveis , Fixação Interna de Fraturas/instrumentação , Magnésio , Teste de Materiais , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Suínos , Porco Miniatura
14.
J Craniomaxillofac Surg ; 42(7): 1428-36, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24864074

RESUMO

PURPOSE: This study aimed to compare the reliability of three different imaging software programs for measuring the PAS and concurrently to investigate the morphological changes in oropharyngeal structures in mandibular prognathic patients before and after orthognathic surgery by using 2D and 3D analyzing technique. MATERIAL AND METHODS: The study consists of 11 randomly chosen patients (8 females and 3 males) who underwent maxillomandibular treatment for correction of Class III anteroposterior mandibular prognathism at the University Hospital in Zurich. A set of standardized LCR and CBCT-scans were obtained from each subject preoperatively (T0), 3 months after surgery (T1) and 3 months to 2 years postoperatively (T2). Morphological changes in the posterior airway space (PAS) were evaluated longitudinally by two different observers with three different imaging software programs (OsiriX(®) 64-bit, Switzerland; Mimics(®), Belgium; BrainLab(®), Germany) and manually by analyzing cephalometric X-rays. RESULTS: A significant increase in the upper airway dimensions before and after surgery occurred in all measured cases. All other cephalometric distances showed no statistically significant alterations. Measuring the volume of the PAS showed no significant changes in all cases. All three software programs showed similar outputs in both cephalometric analysis and 3D measuring technique. CONCLUSION: A 3D design of the posterior airway seems to be far more reliable and precise phrasing of a statement of postoperative gradients than conventional radiography and is additionally higher compared to the corresponding manual method. In case of Class III mandibular prognathism treatment with bilateral split osteotomy of the mandible and simultaneous maxillary advancement, the negative effects of PAS volume decrease may be reduced and might prevent a developing OSAS.


Assuntos
Cefalometria/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Imageamento Tridimensional/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Faringe/diagnóstico por imagem , Software/estatística & dados numéricos , Adulto , Pontos de Referência Anatômicos/diagnóstico por imagem , Cefalometria/estatística & dados numéricos , Tomografia Computadorizada de Feixe Cônico/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Osso Hioide/diagnóstico por imagem , Imageamento Tridimensional/estatística & dados numéricos , Masculino , Má Oclusão Classe III de Angle/diagnóstico por imagem , Má Oclusão Classe III de Angle/cirurgia , Osso Nasal/diagnóstico por imagem , Osteotomia de Le Fort/métodos , Osteotomia Sagital do Ramo Mandibular/métodos , Prognatismo/diagnóstico por imagem , Prognatismo/cirurgia , Distribuição Aleatória , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Base do Crânio/diagnóstico por imagem , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA