Facial Swelling in a Toddler Due to a Metastatic High-Risk Neuroblastoma.

Neuroblastoma is a malignant embryonal tumor derived from the neural crest cells of the sympathetic nervous system. Curative therapy is challenging, especially because early-stage diagnosis in toddlers is difficult. Successful treatment of high-risk neuroblastoma is only achieved in approximately half of the cases and requires an immediate interdisciplinary approach. We present a 34-month-old toddler with swelling of the left side of the face of three days duration and a mandibular mass of unknown duration, which was diagnosed as a metastasis of a neuroblastoma. He also had metastases in the kidney, long bones and skull. Despite the poor prognosis in cases of disseminated skeletal involvement and N-myc amplification, the young patient remained free of recurrence during a follow-up period of 36 months after multidisciplinary treatment. The purpose of this case report is to increase awareness of the clinical features of neuroblastoma among pediatric dentists to support early-stage diagnosis and highlight interdisciplinary management.

A simple, effective, universal, and reusable osteotomy tool for jaw reconstructions with microvascular fibula transplants.

BACKGROUND: Precise, expensive individual saw guides are used with increasing frequency for the reconstruction of mandibular defects with fibular grafts. In this report, an alternative is presented - the Multiuse Cutting Jig (MUC-Jig, proprietary development). It is reusable, suitable for all patients, requires simple planning based on conventional CT imaging, and is more economical. METHODS: To investigate its precision, we conducted a nonblinded experimental study, with ten participating craniomaxillofacial surgeons. Osteotomies of four different fibula segments were carried out at the same angulation, with groups defined according to the proximal and distal fixed angulation: 45°, 30°, 15°, or 0°. The sagittal cut was performed proximally, with the coronal cut performed distally. The resulting 40 segments (n = 40) were analyzed with their Tx length (primary endpoint) and osteotomy angles, and compared to the original planning. RESULTS: The mean (SD) relative deviation of all grafts from the original planning was -0.08 mm (1.12) in length and -0.71° (3.15) for the angle. Only 45° (-2.04 ±â€¯3.71°) and 30° (-1.07 ±â€¯2.52°) cuts differed significantly (p < 0.05) from smaller angle grafts. The mean (SD) absolute deviation was 0.81 mm (0.27) in length and 2.13° (0.93) in graft angles. For individual transplants, 45° cuts (1.28 ±â€¯1.03 mm) differed significantly (p < 0.005) from others. We observed no differences in relative length or absolute angle deviation. CONCLUSIONS: The MUC-Jig is precise and cost-effective for osteotomies with medium angles and smooth reconstructions of template-guided procedures.

Fibula Graft Cutting Devices: Are 3D-Printed Cutting Guides More Precise than a Universal, Reusable Osteotomy Jig?

Individual cutting guides for the reconstruction of lower jaw defects with fibular grafts are often used. However, the application of these osteotomy tools is costly and time intensive. The aim of this study was to compare the precision of osteotomies using a 3D-printed guide with those using a universal, reusable, and more cost-efficient Multi-Use Cutting Jig (MUC-Jig). In this non-blinded experimental study, 10 cranio-maxillofacial surgeons performed four graft removals each in a randomized order using the same osteotomy angle, both proximally (sagittal cut) and distally (coronal cut), of a graft (45°, 30°, 15°, or 0°), first with the MUC-Jig then with the 3D-printed cutting guide. The 40 fibula transplants (Tx) of each method (n = 80) were then analyzed concerning their Tx length and osteotomy angles and compared to the original planning data. Furthermore, the surgeons' subjective perception and the duration of the two procedures were analyzed. The mean relative length and mean relative angle deviation between the MUC-Jig (-0.08 ± 1.12 mm; -0.69° ± 3.15°) and the template (0.22 ± 0.90 mm; 0.36° ± 2.56°) group differed significantly (p = 0.002; p = < 0.001), but the absolute deviations did not (p = 0.206; p = 0.980). Consequently, clinically comparable osteotomy results can be achieved with both methods, but from an economic point of view the MUC-Jig is a more cost-efficient solution.

Bruxism, myoarthropathy and psychosomatics / Bruxismus, Myoarthropathie und Psychosomatik

Bruxism and myoarthrophathy lead to a complex set of burdens that can involve both medical and psychological aspects. Muscular tension due to stress affects these burdens and leads to chronic pain. Using a stress model, it was explained how the individual processing of stress leads to varying negative effects on oral health and jaw function. Through a short survey, it is possible for the dentist to assess the extent of the chronic pain and the associated psychosocial burdens, and, when necessary, encourage the patient to undertake psychological guidance. By learning relaxation techniques and pain coping mechanisms, the pain can be reduced. In order to achieve a long lasting successful treatment, one must consider both medical and psychosomatic aspects.

A computer-based comparative quantitative analysis of surgical outcome of mandibular reconstructions with free fibula microvascular flaps.

The free fibula osteoseptocutaneous flap is the standard for reconstruction of extensive mandibular defects. The procedure must be precise to achieve the required functional and aesthetic results. The aim of the present study was to calculate retrospectively the exact differences in surgical outcome based on preoperative and postoperative Computed Tomography data sets. Ten patients with unilateral reconstructions of the mandible with a fibula based on conventional planning were analyzed quantitatively, applying mirroring techniques with direct comparison of the theoretically optimum with the actual reconstruction. The results showed that there is a significant discrepancy between what is actually achieved and the theoretical optimum. The result of the present retrospective analysis shows that there is room for further improvement of the outcome in complex mandible reconstruction cases.

Cranial defect regeneration in a reserved space.

BACKGROUND: Cranial defects exceeding a certain size do not heal spontaneously and require surgical treatment. The prevention of uncontrolled soft-tissue ingrowth is crucial in the bony healing of such defects. METHODS: Bone regeneration of full-thickness cranial defects was assessed in 16 adult New Zealand White rabbits. A single epicranially placed cover was compared with a hollow chamber with an additional barrier on the dural side. After 8 weeks, bone regeneration in the defects was assessed radiologically, histologically, and by fluorescence microscopy. RESULTS: The hollow chamber design resulted in almost complete cranial defect healing. In contrast, five out of 16 defects covered with a single epicranial burr-hole cover showed hardly any visible bone. Inside the reserved space, there was twice as much bone coverage as compared with burr-hole covers only. CONCLUSIONS: Providing a reserved space for bone regeneration reduces the statistical spread significantly and thus makes the clinical outcome more predictable. Use of a hollow chamber can serve as a useful tool to assess the effect of bone-stimulating factors such as growth factors and bone substitutes. Hollow resorbable implants may offer a new approach in bone regeneration by reducing the need for bone autografting and the associated donor-site morbidity.

Early dural reaction to polylactide in cranial defects in rabbits.

Restoring the bone integrity to injured calvariae remains a challenge to surgeons. In this study, the dural biocompatibility of biodegradable poly-L/DL-lactide 80/20 and 70/30 defect covers, designed for guided bone regeneration, was assessed. In each of the 16 test rabbits, bilateral (8.3 mm) cranial defects were created. The different covers were applied to one defect each in every rabbit and consisted of three parts: an epicranial cover, a spacer, and a dural cover. All defects had closed after 8 weeks due to new bone formation. A few giant cells were found at the cover-to-dura interface in equal numbers for both covers. Dural bone formation was present in 15 of 16 rabbits and progressed unhindered by the defect cover or its early degradation products.

Effect of perforations in burr hole covers on cranial bone regeneration in rabbits.

The reconstruction of bone defects is a significant problem in cranio-maxillofacial surgery. In an effort to avoid the known disadvantages of autogenous bone grafting, alternatives have been investigated. Bone substitute materials, degradable or nondegradable, aim at facilitating bone regeneration, while they take over load-bearing functions for a period of time. In this study, the healing of cranial defects in rabbits was assessed using polylactide guiding covers with and without perforations. Bilateral circular cranial defects were produced in 16 New Zealand white rabbits. The defects were covered with extruded and laser cut polylactide burr hole covers, each animal receiving a perforated burr hole cover on one side and a nonperforated one on the contralateral side. Bone seeking fluorochromes were administered at regular intervals. After an observation period of 8 weeks the amount of bone regeneration in the area of the defects was quantified from contact radiographs, and the dynamics of bone formation were assessed by fluorescence microscopy. Stained sections were used to analyze morphologic differences. No signs of adverse tissue reactions or osteolysis were observed. A bone-guiding function was observed for both covers with or without perforations. Intracranial tissue herniation into the defect hindered the regeneration process. Wide intraindividual and interindividual variation became apparent and average defect filling was only 40% within the 8-week observation period. In this model the perforated covers offered no advantage over nonperforated covers. It can be concluded from this study, that the use of external burr hole covers alone does not guarantee a full thickness regeneration of the cranial defect, but it provides a guiding function for promotion of structured bone regeneration.