[Loss of an eye as a result of an odontogenic infection]. / Oogverlies als gevolg van een dentogene infectie.

A 50-year-old woman presented at the outpatient clinic of the department of oral and maxillofacial surgery with a severe swelling around the left eye 1 week after removal of the second molar in the upper jaw. Despite administration of antibiotics 2 days after the removal of the molar because of periorbital swelling, the inflammation spread to the intraorbital space with eventual loss of the left eye. Timely recognition of the symptoms of (the onset of) an orbital infection after dental treatment and immediate referral to an oral and maxillofacial surgeon and/or ophthalmologist for adequate treatment can be vision-saving. Fortunately, orbital infections with an odontogenic cause are rare.

[Multidisciplinary treatment of amelogenesis imperfecta]. / Multidisciplinaire behandeling van amelogenesis imperfecta.

A healthy 13-year-old patient with amelogenesis imperfecta was referred by her orthodontist to the joint consultation hour (Center for Specialised Dentistry and Oral and Maxillofacial Surgery). In addition to her amelogenesis imperfecta, she was diagnosed with a class 2 malocclusion and a mandibular hypoplasia. She was treated successfully through a multidisciplinary approach.

Density of the mandibular ramus (cancellous:cortical bone volume ratio) as a predictor of the lingual fracture pattern in bilateral sagittal split osteotomy.

The aim of this retrospective cohort study was to evaluate the relative amount of cancellous bone in the mandibular ramus as a predictor of lingual fracture patterns after bilateral sagittal split osteotomy (BSSO). The study including 78 consecutive patients (156 osteotomy sites). In preoperative cone-beam computed tomographic (CT) scans, the volumes of cancellous and cortical bone in the BSSO surgical field were estimated. Patients were divided into two groups based on the cancellous:cortical bone ratio. We studied postoperative cone-beam CT scans for lingual fracture lines and subcategorised them according to the lingual split scale (LSS). Generalised linear mixed models (GLMM) were estimated to evaluate the association between the cancellous:cortical bone ratio and the lingual fracture pattern. There was a significant association between the cancellous:cortical bone ratio of the mandibular angle and the lingual fracture pattern after BSSO. Mandibular angles with a relatively small amount of cancellous bone showed significantly more LSS3 fracture lines (OR=1.990, 95%CI 1.043 to 3.796, p=0.043). These mandibular angles also showed more unfavourable fractures (LSS4), although this was not significant (OR=2.352, 95%CI 0.748 to 7.392, p=0.143). The relative amount of cancellous bone in the mandibular angle is significantly associated with the lingual fracture line after BSSO.

Long-term outcomes 1-20 years after autotransplantation of teeth: clinical and radiographic evaluation of 66 premolars and 8 molars.

In this retrospective study we investigated the long-term survival of autotransplanted premolars and molars with incompletely developed roots. The presence of the transplanted teeth and their outcome after autotransplantation was ascertained from clinical and radiographic evaluation by a maxillofacial surgeon or dentist. Kaplan Meier survival curves were estimated for the total population and for the two groups (premolars and molars). Fifty-one patients with 74 transplanted teeth were included, and the median duration of follow-up was 10 (range 1-20) years. Four of 66 premolars and one of 8 molars were removed and the cumulative survival was 95.4% (95% CI 90.3 to 100). The difference in survival between the premolars and molars was not significant. These results show that the long-term survival of autotransplanted teeth is good. Replacement of a single tooth by autotransplantation should therefore always be considered and is preferred when a suitable donor tooth is available.

[Replacing heavily damaged molars with the use of 3D-techniques]. / Vervanging van ernstig beschadigde molaren met behulp van 3D-technieken.

Seriously damaged molars can be replaced by autotransplantation with the help of 3D techniques. In the present case, involving an 18-year old patient, 18, 38 and 48 were used to replace, respectively, 14, 36 and 37. Preoperatively, the width of the crowns and the root development of 18, 38 and 48 were analysed using 3D imaging. During the autotransplantation procedure, the new alveoli are formed with the help of replicas of the donor molars printed in 3D, in order to prevent iatrogenic damage to the actual donor molars.. The extra-alveolar time was less than 2 minutes for all donor molars. Postoperative follow-up showed physiologic integration of the transplanted molars. There was no ankylosis. Autotransplantation with the help of 3D techniques makes it possible to perform complex procedures with good results.

Are there risk factors for osseous mandibular inferior border defects after bilateral sagittal split osteotomy?

PURPOSE: Bone defects of the inferior mandibular border (osseous inferior border defects) can cause unesthetic postoperative outcomes after bilateral sagittal split osteotomy (BSSO). The aim of this study was to estimate the frequency of osseous inferior border defects after BSSO and to identify risk factors for this complication. MATERIALS AND METHODS: This retrospective study included consecutive patients who underwent BSSO for mandibular retrognathia. The primary outcome was the presence/absence of osseous inferior border defects. Predictors included the mandibular movement, rotation of the occlusal plane, postoperative proximal segment position, pattern of lingual fracture, occurrence of bad split, and presence of third molars. RESULTS: The study sample consisted of 200 patients and had a mean follow-up of 13 months. The mean mandibular advancement and rotation was respectively 5.8 mm and 5.4° clockwise. Osseous inferior border defects were present in 7.0% of splits and in 12.5% of patients. Significant risk factors for inferior border defects included increased advancement, increased clockwise rotation, cranial rotation of the proximal segment, and a split originating in the lingual cortex. CONCLUSION: In conclusion, osseous inferior border defects occur significantly more often in cases with large mandibular advancement, increased clockwise rotation of the occlusal plane, malpositioning of the proximal segment, and a split originating in the lingual cortex.

[The 3D printed drilling template for bilateral sagittal osteotomy]. / De 3D-geprinte boormal voor de bilaterale sagittale splijtingsosteotomie.

The bilateral sagittal osteotomy (BSSO) is a widely used surgical technique within orthognatic surgery. The specific osteotomy design may vary from clinic to clinic. The best position of the bone cuts in a BSSO continues to be a point of discussion and probably differs from patient to patient. In addition, standardisation in, for example, research may be desirable. Pre-operative planning using a drilling template in order to position the planned individual saw cuts during BSSO can be of value. To achieve this goal, a pre-operative 3D printed biocompatible drilling template was manufactured for 1 patient on the basis of pre-operative planning. The difference between the pre-operatively determined bone cuts with the assistance of the drilling template and the actual bone cuts was still large.

Coronectomy of the mandibular third molar: Respect for the inferior alveolar nerve.

The aim of this study was to evaluate the outcomes of coronectomy as an alternative surgical procedure to complete removal of the impacted mandibular third molar in patients with a suspected close relationship between the tooth root(s) and the mandibular canal. A total of 151 patients underwent coronectomy and were followed up with clinical examinations and panoramic radiographs for a minimum of 6 months after surgery. None of the patients exhibited inferior alveolar nerve injury. Eruption of the retained root(s) was more frequent in younger patients (18-35 years). Thirty-six patients (23.8%) exhibited insufficient growth of new bone in the alveolar defect, and 11.3% required a second surgical procedure to remove the root remnant(s). Our results indicate that coronectomy can be a reliable alternative to complete removal of the impacted mandibular third molar in patients exhibiting an increased risk of damage to the inferior alveolar nerve on panoramic radiographs.

Incidence and recovery of neurosensory disturbances after bilateral sagittal split osteotomy in different age groups: a retrospective study of 263 patients.

This study aimed to investigate the incidence of neurosensory disturbance (NSD) after bilateral sagittal split osteotomy (BSSO) in different age groups and to assess the probability of sensory recovery in patients aged <19 years, 19-30 years, and >30 years. Hypoaesthesia of the lower lip was assessed subjectively and objectively immediately after BSSO and at 1 week and 1, 6, and 12 months after BSSO. Hypoaesthesia was considered permanent if it was present 1 year after BSSO. The frequency of NSD immediately after surgery was significantly higher in older patients. The cumulative incidence of recovery at 1 year was lower and the mean time to recovery was longer in the older patients, although these differences were not statistically significant. Older age was a significant risk factor for permanent hypoaesthesia, with an incidence of 4.8% per patient aged <19 years, 7.9% per patient aged 19-30 years, and 15.2% per patient aged >30 years. These findings show that the risk of NSD after BSSO is significantly higher in older patients. These results may aid surgeons in preoperative patient counselling and in deciding the optimal age at which to perform BSSO.

Bilateral sagittal split osteotomy in cadaveric pig mandibles: evaluation of the lingual fracture line based on the use of splitters and separators.

OBJECTIVE: To analyze the splitting pathways of the (lingual) fracture lines during a bilateral sagittal split osteotomy (BSSO) in cadaveric pig mandibles. STUDY DESIGN: A BSSO was performed using splitters and separators. Special attention was paid to end the horizontal medial cut at the deepest point of the entrance of the mandibular foramen. RESULTS: Of all lingual fractures, 95% ended in the mandibular foramen. Forty percent of these fractures extended through the mandibular canal and 40% extended inferiorly along the mandibular canal. CONCLUSION: Almost all lingual fracture lines ended in the mandibular foramen, most likely due to the placement of the medial cut in the concavity of the mandibular foramen. The mandibular foramen and canal could function as the path of least resistance in which the splitting pattern is seen. We conclude that a consistent splitting pattern was achieved without increasing the incidence of possible sequelae.

Bilateral sagittal split osteotomy in a mandible previously reconstructed with a non-vascularized bone graft.

We report a bilateral sagittal split osteotomy (BSSO) in a reconstructed mandible. A 28-year-old woman underwent a segmental mandibulectomy due to a multicystic ameloblastoma in the left jaw. After primary plate reconstruction, final reconstruction was performed with a left posterior iliac crest cortico-cancellous autograft. Due to a pre-existing Class II malocclusion, the patient was analyzed for combined orthodontic-surgical treatment. Subsequently, after 1 year of orthodontic treatment, the BSSO was planned. The sagittal split was performed in the remaining right mandible and on the left side in the iliac crest cortico-cancellous autograft. Ten months later, oral rehabilitation was completed with implant placement in the neomandible. Follow-up showed a Class I occlusion, with good function. The patient was very satisfied with the functional and aesthetic results. This case shows that a BSSO can be performed in a reconstructed mandible, without side effects and with good functional and aesthetic results.

Skeletal stability after mandibular advancement in bilateral sagittal split osteotomies during adolescence.

Bilateral sagittal split osteotomy (BSSO) is the most frequently performed surgery for correcting mandibular retrognathia. Few studies have reported the use of BSSO in young patients, as growth may cause relapse. The aim of the present study was to determine the amount of relapse after performing BSSO in patients aged less than 18 years. Patients who had a mandibular advancement by BSSO surgery between January 2003 and June 2008 were evaluated. Eighteen patients were treated before the age of 18 years and compared with patients treated at 20-24 years of age. Cephalometric radiographs were used to determine the amount of relapse. For patients aged less than 18 years, the mean horizontal relapse after 1 year was 0.5 mm, (10.9% of perioperative advancement). For patients aged 20-24 years, the mean relapse was 0.9 mm, (16.4% of perioperative advancement). There were no significant differences between the age groups (p > 0.05). In conclusion, the BSSO procedure is a relatively stable procedure, even during adolescence.

Autotransplantation of two maxillary premolars in a free vascularized fibula reconstructed mandible.

A 10-year-old female patient with a fibula transplant in her left hemimandible due to ameloblastoma treatment was referred for combined orthodontic and surgical planning and treatment to observe and prevent expected asymmetric facial development and malocclusion, because the premolars and molars on the left side of the mandible were missing. The patient had an Angle Class II malocclusion and arch length discrepancy in the upper jaw. The two second premolars in the maxilla were transplanted into the neomandible to create occlusion on the left side and retention for orthodontic treatment. Clinical and radiological examination 3 months postoperatively showed good integration of both premolars without pocket formation. After 4 months, active orthodontic treatment with fixed appliances was started to create sufficient arch space in the upper jaw for both canines to erupt and to extrude and for the transplanted premolars in the lower jaw to rotate and align into the planned positions. This case report demonstrates that autotransplantation of premolars into a fibula transplant can be a successful dental rehabilitation procedure.

[Development and implementation of health targets for children and adolescents. What contribution can the Robert Koch Institute's National Health Interview and Examination Survey for Children and Adolescents (KiGGS) make?]. / Entwicklung und Evaluation der nationalen Gesundheitsziele für Kinder und Jugendliche. Welchen Beitrag leistet der Kinder- und Jugendgesundheitssurvey des Robert Koch-Instituts (KiGGS)?

Health targets are increasingly becoming a health-policy control instrument, both nationally and internationally. In the project gesundheitsziele.de, targets have been formulated for children and adolescents in Germany - currently in the areas of nutrition, exercise, and stress management. Implementing and evaluating health targets requires regularly updated, informative data that allow a comprehensive and precise description of the relevant problems and developments. The Robert Koch Institute's National Health Interview and Examination Survey for Children and Adolescents - conducted during the period from 2003 to 2006 - provides a pool of data with information on virtually all facets of health development during childhood and adolescence which can be used to determine the starting point of the health-targeting process. This article describes the data provided by the survey of the areas nutrition, exercise, and stress management and the contribution these data could make towards further developing and implementing the health targets for children and adolescents.

Endoscopically assisted reduction of anterior table frontal sinus fractures.

AIMS: To present a retrospective series of six patients with endoscopically assisted reduction of anterior table frontal sinus fractures. MATERIALS AND METHODS: The patients with isolated anterior table fractures were treated between April 2005 and June 2006 in the Leiden University Medical Centre. In two of the six patients the procedure was performed under local anaesthesia. The endoscope was introduced via existing lacerations, an incision in a natural skin crease or just above the hairline. The fracture was reduced and if necessary fixed. RESULTS: In all patients restoration of the cosmetic deformity was achieved clinically. CONCLUSION: The use of endoscopes makes minimally invasive reduction of outer table fractures of the frontal sinus possible, even under local anaesthesia.

The unerupted maxillary second molar, due to an overlying and malformed upper third molar: treatment and follow-up.

This retrospective study presents the treatment and follow-up of 20 young patients with 23 impacted upper second molars, due to overlying, impacted upper third molars. The third molars were removed surgically under local anaesthesia. After removal of these palatally obstructing teeth, radiographic and clinical follow-up was performed. The purpose of this study was to evaluate the eruption progress of the upper second molars after surgery. Radiological and/or clinical follow-up showed complete eruption of 19 (83%) of the upper second molars. For those cases treated before the age of 12 years and 4 months (the mean eruption age), all the upper second molars erupted completely. For those cases where surgical removal was undertaken after the mean eruption age, four (17%) of the upper second molars did not completely erupt. It was concluded that early treatment of impacted upper second molars, due to overlying third molars, may lead to more rapid eruption. Further prospective research is necessary to develop guidelines for the removal of palatally obstructing third molars to avoid eruption problems.

[Sport and health among adults in Germany]. / Sport und Gesundheit bei Erwachsenen in Deutschland.

Regularly participating in sports activities can have a positive effect on people's health and is therefore an important area of health promotion. Data of the Telephone Health Survey 2003 indicate that until now there is an unexploited potential for programmes promoting sports: in total 37.3% of men aged 18 years and above and 38.4% of equally aged women do not participate in sports at all; another 20.9% of men and 28.4% of women only engage in sports activities for up to 2 h/week. The highest prevalence of sports activity is seen among young adults, whereas it is lowest among older people. However, the latter slightly increased their sports activity during the last 10 years, while the trend observed among younger adults seems to point rather in the opposite direction. Also relevant for the planning and implementation of group-specific interventions is the observation that persons with low socioeconomic status tend to engage less often in sports than people with middle or high status do. The present study underlines the health relevance of sports participation by presenting inverse relationships between sports activity and behaviour-related health risks such as smoking and obesity as well as a positive effect of sports on self-assessed health.

Alcohol consumption and its relation to cardiovascular risk factors in Germany.

OBJECTIVE: To analyse the association of alcohol consumption and blood lipids, haemostatic factors, and homocysteine in German adults by gender and age groups. DESIGN: Cross-sectional population-based survey. SETTING: Data from the German National Health Interview and Examination Survey 1998, representative for age, gender, community size, and federal state. SUBJECTS: From a sample of 7124 Germans between 18 and 79 y old, 2420 women and 2365 men were selected. Only individuals who were not currently receiving medical treatment or did not have disorders related to cardiovascular disease were selected for this study. RESULTS: Using analyses of variance, mean blood levels of total cholesterol, HDL cholesterol, HDL/total cholesterol ratio, total glycerides, fibrinogen, antithrombin III, and homocysteine adjusted for age, socioeconomic status, East/West Germany residence, body mass index, tobacco use, sports activity, and coffee consumption, if appropriate are presented by alcohol consumption groups (0, >0-10, >10-20, >20-30 and >30 g/day). The HDL/total cholesterol ratio increased with higher alcohol groups up to 10-20 g/day (+15%) for women and >30 g/day (+18%) for men, showing the strongest rise among men aged 55-79 y. Fibrinogen decreased with higher alcohol groups up to 10-20 g/day for women and 20-30 g/day for men. Among women, homocysteine levels showed a U-shaped curve with a minimum of 8.49 mmol/l at 10-20 g alcohol/day (-8%, reference: nondrinking), whereas an inverse association was observed for men. CONCLUSIONS: Moderate alcohol consumption is associated with favourable levels of several cardiovascular risk factors. The most favourable cardiovascular risk factor profile among women was observed among those drinking 10-20 g alcohol/day. Beneficial effects seem to be more pronounced among older men.

[The Child and Adolescent Health Survey: collection of health behavior data from parents and children]. / Der Kinder- und Jugendgesundheitssurvey: Ermittlung des Gesundheitsverhaltens von Eltern und Kindern.

The first German Health Survey for Children and Adolescents will start in 2003. During three years, a representative sample of children and adolescents between 0 and 18 years of age shall be examined and will, together with their parents, be interviewed on health-relevant issues. With this survey, health information on about 18,000 children will be gathered. The health behaviour of the parents as far as their children's health is concerned, as well as the personal health behaviour during adolescence will be assessed, since this will be highly relevant for future health. Questions on nutrition behaviour, eating disorders, alcohol consumption, smoking as well as leisure-time behaviour, with special emphasis on physical activity, will be asked. These questions were tested for feasibility in a one-year pilot study. With this survey, the occurrence of certain unhealthy behaviour characteristics may be documented and risk groups may be identified. This may help to conceptualize prevention measures.