Modified McLaughlin's Dynamic Muscle Support in the 21st Century? A Retrospective Study With a Prospective Follow-Up Analysis for Patients With Long Standing Facial Paralysis.

INTRODUCTION: Facial nerve paralysis can dramatically affect the life of a patient as it leads to significant alterations of the facial symmetry and functional limitations. Various methods exist including free neuromuscular flaps to reanimate patients suffering from uni- or even bilateral facial nerve paralysis. The more than 60-year-old technique described by McLaughlin continues to offer an alternative with distinct advantages for the individual patient. The present study aimed to evaluate clinical outcome and satisfaction of patients treated with a modified McLaughlin's Dynamic Muscle Support. MATERIALS AND METHODS: A total of 13 patients (mean age of 58.4 years) who received a modified McLaughlin's Dynamic Muscle Support due to uni- or bilateral long-standing facial paralysis were included. Medical records were reviewed retrospectively, and patients were contacted for additional follow-up. Patients who agreed to participate in the follow-up study were asked to answer a self-developed questionnaire. RESULTS: In all patients, a rehabilitation of facial symmetry with an improvement of the mimic expression could be achieved. Mean length of inpatient stay was 6.5 days and average duration of surgery was 121 minutes. No surgical site infection occurred. Mean follow-up was 23 months. Most of the patients were fully satisfied with the result and could experience functional and esthetic improvement.Patients who participated in the prospective follow-up study were very satisfied with the esthetic result and functional outcome. CONCLUSIONS: Even in times of advanced microsurgical techniques, McLaughlin's Dynamic Muscle Support appears to be a good alternative for the successful treatment of long-standing facial paralysis.

Following in the footsteps of Hippocrates-interrelation between the incidence of odontogenic abscess and meteorological parameters.

OBJECTIVES: Although many physicians in daily practice assume a connection between odontogenic infections and meteorological parameters, this has not yet been scientifically proven. Therefore, the aim of the present study was to evaluate the incidence of odontogenic abscess (OA) in relation to outdoor temperature and atmospheric pressure. PATIENTS AND METHODS: An analysis of patients with an odontogenic abscess who presented at the emergency department within a period of 24 months was performed. Only patients who had not received surgical or antibiotic treatment prior to presentation and who lived in Berlin/Brandenburg were included. The OA incidence was correlated with the mean/maximum outdoor temperature and atmospheric pressure starting from 14 days before presentation. The statistical analysis was carried out using Poisson regression models with OA incidence as dependent and meteorological parameters as independent variables. RESULTS: A total of 535 patients (mean age 39.4 years; range 1 to 95 years) with 538 cases were included. Of these, 227 were hospitalized. The most frequent diagnosis was a canine fossa abscess. A significant association between mean (p = 0.0153) and maximum temperature (p = 0.008) on the day of the presentation and abscess incidence was observed. Furthermore, a significant correlation between OA incidence and maximum temperature 2 days before presentation was found (p = 0.034). The deviation of the mean temperature on the day of the presentation from the monthly mean temperature had a significant influence (p = 0.021) on the incidence of OA. In contrast to temperature, atmospheric pressure had no significant influence on the incidence of OA. CONCLUSION: This study supports a relationship between the incidence of odontogenic abscess and outdoor temperature, but not atmospheric pressure. A significantly higher frequency of patients with an OA presented at our emergency department on days with (comparably) low and high outdoor temperatures. Furthermore, a significant correlation between incidence and maximum temperature 2 days before presentation was found. CLINICAL RELEVANCE: The treatment of odontogenic infections has become a significant economic burden to public health care facilities. The results of this study may help to adapt the numbers of doctors/dentists on duty in relation to different weather conditions. In any case, it is an impetus to think outside the box.

[Frequency and management of complex facial fractures-an oral and maxillofacial surgical assessment]. / Häufigkeit und Management von Gesichtsschädelfrakturen ­ eine MKG-chirurgische Einschätzung.

INTRODUCTION: The treatment of facial fractures is an integral part of the oral and maxillofacial surgical treatment spectrum. In the case of complex fractures that involve multiple levels of the facial skeleton associated with severe concomitant injuries, an individual and interdisciplinary treatment approach is needed, which requires the infrastructure of a national trauma center. OBJECTIVE: The aim of this study was to analyze the incidence and management of patients with complex facial fractures and considering the concomitant injury pattern. MATERIAL AND METHODS: A retrospective analysis of patients with complex facial fractures during the years 2009-2015 admitted to the emergency surgical department of a national trauma center was carried out. The identification of appropriate patient cases was based on the International Statistical Classification of Diseases and Related Health Problems (ICD) coding of electronic patient data. Only patients with at least a combination of mandibular and midfacial fractures (2-level fractures) were considered. Patients with mainly dentoalveolar fractures and simple nasal bone fractures were not included. The evaluation of the electronic medical records included the etiology, fracture pattern, associated severe injuries on the basis of the injury severity score (ISS), treatment regimen as well as the length of the hospital stay. RESULTS: In the 7­year study period, 3382 patients were identified with facial fractures. Of these, 128 patients (3.78%) presented with a complex fracture pattern with a combination of mandibular fractures and fractures of the midface. The majority of these patients (n = 92) had less severe concomitant injuries (ISS ≤ 16), while 36 patients showed severe concomitant injuries (ISS > 16). The incidence of a 3-level fracture involving the mandible, midface and anterior skull base was only 0.47% and could be detected in 16 patients, of which 10 were classified as polytrauma (ISS > 16). CONCLUSION: The incidence of complex fractures of the facial skeleton was comparatively low with almost 4%. More than one in four patients with complex injury patterns of the facial skeleton exhibited severe concomitant life-threatening injuries, necessitating an interdisciplinary management with the specialized infrastructure of a nationwide trauma center.

Clinical outcome after orbital floor fracture reduction with special regard to patient's satisfaction.

PURPOSE: Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures. The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient's complaints after fracture reduction. METHODS: A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil (ethisorb sheet or polydioxanone foil). A follow-up assessment including ophthalmological evaluation regarding visual acuity (eye chart projector), binocular visual field screening (Bagolini striated glasses test) and diplopia (cover test, Hess screen test) was conducted. Additionally, a questionnaire was performed to assess patients' satisfaction. RESULTS: A total of 53 patients with a mean follow-up of 23 months (ranging from 11 to 72) after surgical therapy were included. Diplopia was present preoperatively in 23 (43.4%) and reduced in follow-up examination (n = 12, 22.6%). Limitations in ocular motility reduced from 37.7% to 7.5%. The questionnaire about the patient's satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters. CONCLUSION: Transconjunctival approach is a safe approach for orbital fracture therapy. Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment.

Basal subtype is predictive for response to cetuximab treatment in patient-derived xenografts of squamous cell head and neck cancer.

Cetuximab is the single targeted therapy approved for the treatment of head and neck cancer (HNSCC). Predictive biomarkers have not been established and patient stratification based on molecular tumor profiles has not been possible. Since EGFR pathway activation is pronounced in basal subtype, we hypothesized this activation could be a predictive signature for an EGFR directed treatment. From our patient-derived xenograft platform of HNSCC, 28 models were subjected to Affymetrix gene expression studies on HG U133+ 2.0. Based on the expression of 821 genes, the subtype of each of the 28 models was determined by integrating gene expression profiles through centroid-clustering with previously published gene expression data by Keck et al. The models were treated in groups of 5-6 animals with docetaxel, cetuximab, everolimus, cis- or carboplatin and 5-fluorouracil. Response was evaluated by comparing tumor volume at treatment initiation and after 3 weeks of treatment (RTV). Tumors distributed over the 3 signature-defined subtypes: 5 mesenchymal/inflamed phenotype (MS), 15 basal type (BA), 8 classical type (CL). Cluster analysis revealed a strong correlation between response to cetuximab and the basal subtype. RTV MS 3.32 vs. BA 0.78 (MS vs. BA, unpaired t-test, p 0.0002). Cetuximab responders were distributed as following: 1/5 in MS, 5/8 in CL and 13/15 in the BA group. Activity of classical chemotherapies did not differ between the subtypes. In conclusion basal subtype was associated with response to EGFR directed therapy in head and neck squamous cell cancer patient-derived xenografts.

Treatment of Wound Healing Disorders of Radial Forearm Free Flap Donor Sites Using Cold Atmospheric Plasma: A Proof of Concept.

PURPOSE: The treatment of wound healing disturbances of the radial forearm free flap donor site after reconstructive surgery is typically long and burdensome and often requires additional surgery. Cold atmospheric plasma is a promising approach to overcome these impairments. The aim of this proof of concept study was to evaluate the clinical outcome of plasma irradiation in patients with wound healing disorders with exposed brachial tendons of the radial forearm. PATIENTS AND METHODS: Four patients (mean age 64.2 years, range 44 to 80) who had undergone radial forearm free flap procedures and developed wound healing disturbance leading to exposed flexor tendons were included in the present prospective case series. In addition to routine wound care, all sites were irradiated with cold atmospheric plasma. The primary outcome variable was complete wound closure. RESULTS: In all patients, complete wound repair in terms of the absence of tendon exposure was observed within a mean treatment time of 10.1 weeks (range 4.9 to 16). No undesirable side effects were observed, and no inflammation or infection occurred. CONCLUSIONS: Cold atmospheric plasma could offer a reliable conservative treatment option for complicated wound healing disturbances. This was exemplarily shown in the case of radial forearm free flap donor site morbidity with exposed flexor tendons in the present study.

Cold plasma: a novel approach to treat infected dentin-a combined ex vivo and in vitro study.

OBJECTIVES: The aim of this study was to evaluate the antimicrobial effect of cold plasma (CP) on infected dentin surfaces in vitro and ex vivo. MATERIALS AND METHODS: To examine the effect of cold plasma on root surfaces, 24 root surfaces were infected with Streptococcus mitis. Specimens were randomly divided into three groups: Within the control group (C), root surfaces were rinsed with NaCl; root surfaces in the second group were additionally scaled and root planed (SRP), and in the third group, root surfaces were rinsed, scaled, root planed, and in addition, CP was applied (SRP + CP). To examine the effect of CP on root caries lesions (RCLs), 16 freshly extracted teeth with symmetrical carious lesions were equally divided into two groups. In the control group, carious lesions were treated with chlorhexidine (CHX), whereas CHX was applied in conjunction with CP in the test group (CHX + CP). For microbiological analysis, dentin samples were serially diluted and CFU counts were estimated after 24 h of incubation. RESULTS: Compared to C, mean CFU values for SRP and SRP + CP were significantly lower (p < 0.05). In addition, mean CFUs for SRP + CP were reduced to 0 and, therefore, significantly lower than SRP (2.98 log CFU/mL) alone (p = 0.000, Mann-Whitney U). Regarding RCLs, significantly lower mean CFU values were observed for CHX + CP when compared to CHX (4.45 vs. 2.67 log CFU/mL, p = 0.002, Mann-Whitney U test). CONCLUSIONS: For disinfection of exposed root surfaces, the adjunctive application of CP is promising. In addition, the combined application of CHX + CP has the potential to disinfect root dentin surfaces. CLINICAL RELEVANCE: It was shown that the combination of cold plasma with CHX is the best available option for the disinfection of root surfaces.

Severe tooth loss after root damage caused by predrilled intermaxillary fixation screw: a case report.

Intermaxillary fixation (IMF) with screws is routinely used as a conservative therapy or to obtain normal occlusion during the surgical procedure of open reduction and internal fixation for treating mandibular fractures. The risk of iatrogenic dental damage caused by interdental drilling is widely known. Several side effects are described, including loss of response to pulp sensibility testing, root fracture, and, loss of the tooth. This is a case report about a young man who had undergone temporary IMF treatment with a single proven root damage. The patient did not appear for follow-up but he presented 5 years afterward with local purulent osteomyelitis concerning the affected and the adjacent teeth. Osteotomy and extraction of two premolars and one molar were necessary for rehabilitation. This case report illustrates the importance of careful use of predrilled IMF screws and the necessity of frequent follow-ups in cases of proven tooth root damage due to IMF treatment.

A comprehensively characterized large panel of head and neck cancer patient-derived xenografts identifies the mTOR inhibitor everolimus as potential new treatment option.

Patient-derived xenograft (PDX) models have shown to reflect original patient tumors better than any other preclinical model. We embarked in a study establishing a large panel of head and neck squamous cell carcinomas PDX for biomarker analysis and evaluation of established and novel compounds. Out of 115 transplanted specimens 52 models were established of which 29 were characterized for response to docetaxel, cetuximab, methotrexate, carboplatin, 5-fluorouracil and everolimus. Further, tumors were subjected to sequencing analysis and gene expression profiling of selected mTOR pathway members. Most frequent response was observed for docetaxel and cetuximab. Responses to carboplatin, 5-fluorouracil and methotrexate were moderate. Everolimus revealed activity in the majority of PDX. Mutational profiling and gene expression analysis did not reveal a predictive biomarker for everolimus even though by trend RPS6KB1 mRNA expression was associated with response. In conclusion we demonstrate a comprehensively characterized panel of head and neck cancer PDX models, which represent a valuable and renewable tissue resource for evaluation of novel compounds and associated biomarkers.

Survival analysis of dental implants and implant-retained prostheses in oral cancer patients up to 20 years.

OBJECTIVES: The purpose of this study was to evaluate the long-term survival rate and potential influencing factors of dental implants and implant-retained prostheses in oral cancer patients who had undergone surgical tumor resection. MATERIAL AND METHODS: In the present study, 157 patients (95 females and 62 males with a mean age of 53.7 years) with 830 implants were included. All patients were diagnosed with a malignant tumor in the oral cavity and had undergone ablative surgery. In 55 patients (292 implants), the surgical procedure was followed by an additional radiochemotherapy (RCT) before implant placement. Nicotine users who received RCT were excluded from this study. Patients were clinically examined every 6 or 12 months according to a standard procedure. RESULTS: Of the 830 examined implants, 450 were placed in the maxilla and 380 in the mandible. A total of 65 implants were lost, 36 in the maxilla and 29 in the mandible; of these, 42 implants (65%) were documented as lost due to the patient's death. The mean observation period was 121 months. The cumulative survival rate was 94.9% at 3 years and 92.5% at 7 years. With an observation period up to 20 years, the cumulative survival rate remained constant after 11 years with 90.8%. Age, gender, and localization (maxilla/mandible) of implants did not show any influence on the survival of the implants. However, radiochemotherapy was determined as a significant factor influencing the survival rate. CONCLUSIONS: The results of this study demonstrate that the survival rate of implants was significantly lower in oral cancer patients who had been treated by ablative surgery and additional radiochemotherapy than in patients without RCT. Since there is no significant difference in the mortality rate of patients with additional RCT compared to patients who underwent sole ablative surgery, the higher loss ratio is due to a late failure of osseointegration. CLINICAL RELEVANCE: Dental implants in oral cancer patients who had been treated by ablative surgery show a high and steady cumulative survival rate after 11 years. Implant survival of patients with additional RCT is significantly lower. Non-smoking-irradiated patients seem to have a better implant survival.

Patient-Specific Implant in Prosthetic Craniofacial Reconstruction: First Report of a Novel Technique With Far-Reaching Perspective.

BACKGROUND: Application of endosseous implants in prosthetic craniofacial reconstruction represents a secure and reliable method and is a well-established surgical procedure. In areas of low bone presentation, standardized plate-like titanium implants are available. For allowing a congruent fitting to the recipient site, these contemporary implants have to be manually adapted--implicating drawbacks in terms of time consumption, technical complexity, and insufficient functional outcome. Owing to these limitations, a custom-made patient-specific implant is introduced based on Digital Imaging and Communications in Medicine (DICOM) data and designed for optimal prosthetic reconstruction. METHODS: For the first time, the application of a prefabricated patient-specific implant for retaining a craniofacial prosthesis is described. In a 64-year-old man with partial nasal defect standardized plate-like implants failed because of compromised bone quality due to Osler disease. To realize an implant-retained prosthetic reconstruction, a patient-specific implant was fabricated based on computer-aided design and computer-aided manufacturing (CAD/CAM) technology. This technique allows for considering the implant's ideal geometry as well as its correct placement of the required magnetic abutments. Furthermore, the surface of the implant can be designed for optimal hygienic conditions. RESULTS: The patient-specific implant was successfully inserted in a time effective operating procedure. Follow-up at 6 months showed an excellent functional and aesthetic outcome. CONCLUSIONS: Application of prefabricated patient-specific implants offers prospectively an ideal tool for retaining craniofacial prostheses and should be considered a viable option in standard cases, but obligatory in anatomically demanding defects.

The role of lipolysis in human orosensory fat perception.

Taste perception elicited by food constituents and facilitated by sensory cells in the oral cavity is important for the survival of organisms. In addition to the five basic taste modalities, sweet, umami, bitter, sour, and salty, orosensory perception of stimuli such as fat constituents is intensely investigated. Experiments in rodents and humans suggest that free fatty acids represent a major stimulus for the perception of fat-containing food. However, the lipid fraction of foods mainly consists of triglycerides in which fatty acids are esterified with glycerol. Whereas effective lipolysis by secreted lipases (LIPs) liberating fatty acids from triglycerides in the rodent oral cavity is well established, a similar mechanism in humans is disputed. By psychophysical analyses of humans, we demonstrate responses upon stimulation with triglycerides which are attenuated by concomitant LIP inhibitor administration. Moreover, lipolytic activities detected in minor salivary gland secretions directly supplying gustatory papillae were correlated to individual sensitivities for triglycerides, suggesting that differential LIP levels may contribute to variant fat perception. Intriguingly, we found that the LIPF gene coding for lingual/gastric LIP is not expressed in human lingual tissue. Instead, we identified the expression of other LIPs, which may compensate for the absence of LIPF.

The human TAS2R16 receptor mediates bitter taste in response to beta-glucopyranosides.

Bitter taste generally causes aversion, which protects humans from ingesting toxic substances. But bitter flavors also contribute to the palatability of food and beverages, thereby influencing nutritional habits in humans. Although many studies have examined bitter taste, the underlying receptor mechanisms remain poorly understood. Anatomical, functional and genetic data from rodents suggest the existence of a family of receptors that are responsive to bitter compounds. Here we report that a human member of this family, TAS2R16, is present in taste receptor cells on the tongue and is activated by bitter beta-glucopyranosides. Responses to these phytonutrients show a similar concentration dependence and desensitization in transfected cells and in experiments assessing taste perception in humans. Bitter compounds consisting of a hydrophobic residue attached to glucose by a beta-glycosidic bond activate TAS2R16. Thus, TAS2R16 links the recognition of a specific chemical structure to the perception of bitter taste. If the ability of TAS2R16 to detect substances with common molecular properties is typical of the bitter receptor family, it may explain how a few receptors permit the perception of numerous bitter substances.

Microvascular reconstructions in oral and maxillofacial surgery - Results of a survey among oral and maxillofacial surgeons in Germany, Austria, and Switzerland.

This study aimed to evaluate the use of microvascular free flaps (MFF) in oral and maxillofacial surgery (OMFS) in Germany, Austria, and Switzerland. A dynamic online questionnaire, using 42-46 questions, was sent to OMF surgeons based in hospitals in Germany, Austria, and Switzerland. The questionnaire was evaluated internally and externally. Aside from general information, data were collected on organizational aspects, approaches, MFF types and frequency, presurgical planning, intraoperative procedures, perioperative medications, flap monitoring, and patient management. Participants mostly performed 30-40 MFF each year (11/53). Most stated that the COVID-19 pandemic did influence MFF frequency (25/53) to varying extents. Radial forearm flap was most frequently used (37/53), followed by ALT (5/53), and fibula flap (5/53). Primary reconstruction was performed by most participants (35/48). Irradiated bony transplants were mostly used for implant placement after 12 months (23/48). Most participants (38/48) used reconstruction plates, followed by miniplates (36/48), PSI reconstruction (31/48), and PSI miniplates (10/48). Regarding the postoperative use of anticoagulants, low-molecular-weight (37/48) and unfractioned heparins (15/48) were widely used, most often for 3-7 days (26/48). Clinical evaluation was mostly preferred for flap monitoring (47/48), usually every 2 h (34/48), for at least 48 h (19/48). Strong heterogeneity in MFF reconstructions in OMFS was found, especially regarding the timepoints of reconstruction, types of osteosynthesis, and postoperative MFF management. These findings provide the chance to further compare the different treatment algorithms regarding relevant MFF aspects, such as postoperative management. This could create evidence-based treatment algorithms that will further improve the clinical outcomes in MFF reconstructions.

Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients.

Aim: To assess the diagnostic and therapeutic approaches in pediatric mandibular fractures with regards to fracture pattern and localization. Patients and methods: This retrospective study included patients under the age of 17 years that presented to the Department of Oral and Maxillofacial Surgery at Charité-Universitätsmedizin Berlin with mandibular fractures over an 11-year long period (2010-2020). Medical records were analyzed for age, gender, injury mechanism, clinical presentation, imaging modalities, fracture pattern, and fracture management. Statistical analyses included descriptive statistics, normality testing, and Mann-Whitney U tests. Results: A total of 91 pediatric patients (23 females and 68 males) presented with mandibular fractures. The majority of mandibular fractures occurred in patients aged 13-16 years (67.0%, n = 61). The main causes were activities of daily life (34.1%), followed by assault (25.3%). Malocclusion and pain upon mandibular joint compression were documented in 72.5% and 51.7% of patients, respectively. The most frequently applied radiological diagnostic tool was a panoramic X-ray (49.5%). The main fracture patterns were single (42.9%) and double fractures (48.4%). An age-adapted surgical approach using open reduction and internal fixation (ORIF) was the most frequent management (61.5%). A conservative approach was favored in cases of condylar head fractures. Resorbable plates were used in eight cases of ORIF (8.8%). Conclusion: Treatment regimens should be carefully selected based on the unique anatomy of the pediatric patient with regards to centers of growth and dentition phase, to restore stomatognathic function and to maintain adequate skeletal growth and eruption of teeth. Clinical significance: This study illustrates the challenges of mandibular fracture management in the pediatric patient. How to cite this article: Hofmann E, Koerdt S, Heiland M, et al. Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients. Int J Clin Pediatr Dent 2023;16(3):499-509.

Clinical Success of Periorbital Craniofacial Implants: Introduction of a Staging System and Treatment Algorithm for Peri-implant Infections.

Purpose: To compare different assessment methods for peri-implant inflammation to evaluate potential risk factors and to generate a comprehensive algorithm for clinical staging, treatment, and evaluation of success in periorbital implants. Materials and Methods: In this hospital-based cross-sectional study, 111 periorbital implants in 40 patients with orbital defects after exenteration were clinically analyzed. Skin reaction according to Holgers (SRH), probing depth (PD) , and sulcus fluid flow rate (SFFR), as well as patient-specific data, such as age, sex, smoking and irradiation status, cleaning agent and frequency, defect etiology, implant system, implant location, time span since implantation, and type of retention, were assessed and statistically analyzed via mixed-model calculations. Success was defined as the absence of necessary invasive or antibiotic treatment. Results: A total of 62 implants (55.9%) had been placed in male patients and 49 implants (44.1%) in female patients. There were 18 patients (52 implants, 46.8%) who had received radiotherapy. Mean inflammation levels were low. PD and SFFR were highly correlated, whereby PD increased significantly with time after implantation. SRH ≥ 2 was correlated significantly with higher PD and SFFR values. While 80% of the implants did not require invasive or antibiotic treatment, 45% of the patients presented at least one affected implant. The data gathered allowed for the definition of a staging and treatment algorithm for peri-implantitis in periorbital implants. No patient-specific factors showed a significant impact on peri-implant inflammation. Conclusion: Periorbital implant restorations with magnetic abutments are a safe treatment option for orbital defects. PD and SRH were proven to be valuable quick assessment tools and should be complemented by SFFR, if inconclusive. The established parameters for the staging of peri-implant tissue health and clinical success can serve as a viable tool for reliable and comparable assessment in clinical and scientific settings. Further studies are necessary to assess the suggested treatment algorithm.

Management of the Contralateral Neck in Unilateral Node-Positive Oral Squamous Cell Carcinoma.

INTRODUCTION: In lateralized oral squamous cell carcinoma (OSCC) with ipsilateral cervical lymph node metastasis (CLNM), the surgical management of the unsuspicious contralateral neck remains a matter of debate. The aim of this study was to analyze this cohort and to compare the outcomes of patients with and without contralateral elective neck dissection (END). MATERIAL AND METHODS: A retrospective analysis of patients with lateralized OSCC, ipsilateral CLNM (pN+) and contralateral cN0-stage was performed. Patients were divided into two groups according to the surgical management of the contralateral neck: I: END; and II: no END performed. Adjuvant radiotherapy was applied bilaterally in both groups according to individual risk. RESULTS: A total of 65 patients (group I: 16 (24.6%); group II: 49 (75.4%)) with a median follow-up of 28 months were included. Initially, there was no case of contralateral CLNM after surgery. During follow-up, 6 (9.2%) patients presented with recurrent CLNM. In 5 of these cases (7.7%), the contralateral neck (group I: 3/16 (18.8%); group II: 2/49 (4.1%)) was affected. Increased ipsilateral lymph node ratio was associated with contralateral CLNM (p = 0.07). END of the contralateral side showed no significant benefit regarding OS (p = 0.59) and RFS (p = 0.19). CONCLUSIONS: Overall, the risk for occult contralateral CLNM in patients with lateralized OSCC ipsilateral CLNM is low. Our data suggest that END should not be performed routinely in this cohort. Risk-adapted radiotherapy of the contralateral neck alone seems to be sufficient from the oncological point of view.

Quality of life and psychological evaluation of patients after anaplastology.

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.

G protein-coupled receptors in human fat taste perception.

In contrast to carbohydrates and proteins, which are detected by specialized taste receptors in the forms of their respective building blocks, sugars, and L-amino acids, the third macronutrient, lipids, has until now not been associated with gustatory receptors. Instead, the recognition of fat stimuli was believed to rely mostly on textural, olfactory, and postingestive cues. During the recent years, however, research done mainly in rodent models revealed an additional gustatory component for the detection of long-chain fatty acids (LCFAs), the main taste-activating component of lipids. Concomitantly, a number of candidate fat taste receptors were proposed to be involved in rodent's gustatory fatty acid perception. Compared with rodent models, much less is known about human fat taste. In order to investigate the ability of the human gustatory system to respond to fat components, we performed sensory experiments with fatty acids of different chain lengths and derivatives thereof. We found that our panelists discriminated a "fatty" and an irritant "scratchy" taste component, with the "fatty" percept restricted to LCFAs. Using functional calcium-imaging experiments with the human orthologs of mouse candidate fat receptors belonging to the G protein-coupled receptor family, we correlated human sensory data with receptor properties characterized in vitro. We demonstrated that the pharmacological activation profile of human GPR40 and GPR120, 2 LCFA-specific receptors associated with gustatory fat perception in rodents, is inconsistent with the "scratchy" sensation of human subjects and more consistent with the percept described as "fatty." Expression analysis of GPR40 and GPR120 in human gustatory tissues revealed that, while the GPR40 gene is not expressed, GPR120 is detected in gustatory and nongustatory epithelia. On a cellular level, we found GPR120 mRNA and protein in taste buds as well as in the surrounding epithelial cells. We conclude that GPR120 may indeed participate in human gustatory fatty acid perception.

Histological Processing of CAD/CAM Titanium Scaffold after Long-Term Failure in Cranioplasty.

Cranioplasty is a frequently performed procedure after craniectomy and includes several techniques with different materials. Due to high overall complication rates, alloplastic implants are removed in many cases. Lack of implant material osseointegration is often assumed as a reason for failure, but no study has proven this in cranioplasty. This study histologically evaluates the osteointegration of a computer-aided design and computer-aided manufacturing (CAD/CAM) titanium scaffold with an open mesh structure used for cranioplasty. A CAD/CAM titanium scaffold was removed due to late soft tissue complications 7.6 years after cranioplasty. The histological analyses involved the preparation of non-decalcified slices from the scaffold's inner and outer sides as well as a light-microscopic evaluation, including the quantification of the bone that had formed over the years. Within the scaffold pores, vital connective tissue with both blood vessels and nerves was found. Exclusive bone formation only occurred at the edges of the implant, covering 0.21% of the skin-facing outer surface area. The inner scaffold surface, facing towards the brain, did not show any mineralization at all. Although conventional alloplastic materials for cranioplasty reduce surgery time and provide good esthetic results while mechanically protecting the underlying structures, a lack of adequate stimuli could explain the limited bone formation found. CAD/CAM porous titanium scaffolds alone insufficiently osseointegrate in such large bone defects of the skull. Future research should investigate alternative routes that enable long-term osteointegration in order to reduce complication rates after cranioplasty. Opportunities could be found in mechano-biologically optimized scaffolds, material modifications, surface coatings, or other routes to sustain bone formation.