Miniplates Versus Reconstruction Plates in Vascularized Osteocutaneous Flap Reconstruction of the Mandible.

PURPOSE: The main aim of this article is to compare the complication rate associated with the use of miniplates versus reconstruction plates in vascularized osteocutaneous flap reconstruction of the mandible. PATIENTS AND METHODS: The authors searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov up to September 2017 to identify studies that compared the complication rate of miniplates versus reconstruction plates in patients undergoing mandibular reconstruction. Two reviewers individually extracted the data and performed a quality assessment. Plate exposure, plate fracture/removal, infection, and overall complications were evaluated. RESULTS: Five studies with 511 cases were included in our analysis. No significant difference was found between the groups. However, the reconstruction plate led to fewer overall complications and plate exposure postoperatively than did the miniplate. CONCLUSION: Our meta-analysis suggests that miniplates and reconstruction plates are suitable for mandibular reconstruction with a vascularized osteocutaneous flap.

Incidence of Palatal Fistula at Time of Secondary Alveolar Cleft Reconstruction.

OBJECTIVE: We aim to establish consistent time points for evaluating palatal fistula incidence to standardize reporting practices and clarify prospective literature. DESIGN: An institutional retrospective chart review was conducted on 76 patients with unilateral or bilateral complete cleft lip and palate who underwent secondary alveolar bone grafting between 2006 and 2015. MAIN OUTCOME MEASURES: Early fistula incidence rates were reported prior to maxillary expansion, and late fistula rates were reported at the time of alveolar bone grafting. Fistula recurrence rates after primary repair were also measured. RESULTS: We found an early fistula incidence rate of 20% (n = 15) and a late fistula rate of 55% (n = 42) at the time of secondary ABG. Fistulae recurred after initial repair in 43% of cases. Fistulae were classified using the Pittsburgh Classification System as type III (33%), type IV (60%), or type V (7%). The presence of a bilateral cleft ( P = 0.01) and history of early fistula repair ( P < 0.01) were associated with late fistula incidence in a univariate analysis. In a logistic regression model, only early fistula repair was associated with late fistula incidence (OR = 17.17) and overall likelihood of recurrence (OR = 70.89). CONCLUSIONS: Early fistulae should be reported prior to orthodontic expansion of the maxillary arch. Late fistulae should be reported at the time of ABG, following palatal expansion. Patients who develop an early fistula after palatoplasty are likely to experience recurrent fistula formation.

A Proposal of New Classification for Dental Implant Complications.

AIM: The aims of this study are to review the available literature related to implant complications and propose a new classification method for dental implant complications. MATERIALS AND METHODS: Dental literature was reviewed via PubMed focusing on articles published in English, which included data regarding dental implants, complications, and classification from January 2000 to January 2018. The author, who has experience with implant placement and restorations for 15 years, and ten of his colleagues, formed a list of implant complications that they have encountered in their practices. RESULTS: After 3,736 articles were found in the initial search, a total of 613 potentially relevant review articles were identified in the database. After the full-text analysis of 25 articles, only 6 review articles with complication classifications were utilized in this study. In addition, a clinically based classification named "Turkyilmaz's Classification of Implant Complications" including three categories was created. Types of complications in these three groups (Mild, Moderate, and Severe) were listed, and some of them were illustrated. Also, recommendations for clinicians were made on how to avoid these problems and/or overcome them. CONCLUSION: It has been suggested that categorical data regarding complications of dental implants are limited, and the new complication classification presented in this article may help clinicians identify and overcome commonly encountered implant complications. CLINICAL SIGNIFICANCE: For clinicians, it is important to know possible complications regarding dental implants. In this article, a group of dentists created and suggested a new classification for implant complications, which may help clinicians identify commonly encountered complications and how to handle them in the clinic.

[Remote results of eversion carotid endarterectomy depending on the suture material used]. / Otdalennye rezul'taty éversionnoi karotidnoi éndarteréktomii v zavisimosti ot ispol'zuemogo shovnogo materiala.

BACKGROUND: It is known that namely long-term presence of suture material as the only foreign body in autologous conditions may lead to restenosis in the remote period. Such hypothesis was put forward based on good results of reconstructive cardiovascular operations in case of using absorbable suture material. OBJECTIVE: Our study was aimed at comparative analysis of remote results of using absorbable suture material polydioxanone and non-absorbable suture material polypropylene in eversion carotid endarterectomy. PATIENTS AND METHODS: Over the period from 2002 to 2007, at the Department of Vascular Surgery of the Institute of Surgery named after A.V. Vishnevsky performed a total of 408 carotid reconstructions according to the eversion technique. The study was based on comparative analysis of the remote results of this procedure in two groups of patients: the first group consisted of 121 patients in whom replantation of the internal carotid artery into the common carotid artery was performed using absorbable suture material polydioxanone with the metric sizes 5-0 and 6-0 and the second group comprising 135 patients in whom similar manipulations were performed using non-absorbable suture material polypropylene with the metric size 6-0. In the course of the study it turned out that the remote results might also be influenced by the metric size of polydioxanone, therefore the first group was further subdivided into subgroups: polydioxanone 5-0 - 79 patients and polydioxanone 6-0 - 42 patients. RESULTS: At baseline, with statistically significant differences by the gender, incidence of unstable atherosclerotic plaque, diameter of the ipsilateral internal carotid artery ≤4 mm, the groups of patients turned out to be in the remote period statistically significantly comparable by such parameters as frequency of the development of a pseudoaneurysm, restenosis of the internal carotid artery, ipsilateral stroke, restenosis-associated stroke, and by survival. However, when comparing the subgroup of patients wherein polydioxanone 6-0 was used and the second group with the initially statistically significant differences by incidence of unstable atherosclerotic plaque and myocardial infarction, in the remote period there was a statistically significant decrease in the incidence rate of restenosis of the internal carotid artery in the first case. CONCLUSIONS: The obtained findings suggested that the absorbable suture material polydioxanone with the metric size 6-0 might be considered as quite a substantiated alternative to the used in cardiovascular surgery non-absorbable suture material polypropylene. Polydioxanone with the metric size 6-0 made it possible to remove or considerably decrease the incidence rate of the development of restenosis of the internal carotid artery after eversion carotid endarterectomy.

Prospective multicenter study of a synthetic bioabsorbable anal fistula plug to treat cryptoglandular transsphincteric anal fistulas.

BACKGROUND: Although interest in sphincter-sparing treatments for anal fistulas is increasing, few large prospective studies of these approaches have been conducted. OBJECTIVE: The study assessed outcomes after implantation of a synthetic bioabsorbable anal fistula plug. DESIGN: A prospective, multicenter investigation was performed. SETTING: The study was conducted at 11 colon and rectal centers. PATIENTS: Ninety-three patients (71 men; mean age, 47 years) with complex cryptoglandular transsphincteric anal fistulas were enrolled. Exclusion criteria included Crohn's disease, an active infection, a multitract fistula, and an immunocompromised status. INTERVENTION: Draining setons were used at the surgeon's discretion. Patients had follow-up evaluations at 1, 3, 6, and 12 months postoperatively. MAIN OUTCOME MEASURES: The primary end point was healing of the fistula, defined as drainage cessation plus closure of the external opening, at 6 and 12 months. Secondary end points were fecal continence, duration of drainage from the fistula, pain, and adverse events during follow-up. RESULTS: Thirteen patients were lost to follow-up and 21 were withdrawn, primarily to undergo an alternative treatment. The fistula healing rates at 6 and 12 months were 41% (95% CI, 30%-52%; total n = 74) and 49% (95% CI, 38%-61%; total n = 73). Half the patients in whom a previous treatment failed had healing. By 6 months, the mean Wexner score had improved significantly (p = 0.0003). By 12 months, 93% of patients had no or minimal pain. Adverse events included 11 infections/abscesses, 2 new fistulas, and 8 total and 5 partial plug extrusions. The fistula healed in 3 patients with a partial extrusion. LIMITATIONS: The study was nonrandomized and had relatively high rates of loss to follow-up. CONCLUSION: Implantation of a synthetic bioabsorbable fistula plug is a reasonably efficacious treatment for complex transsphincteric anal fistulas, especially given the simplicity and low morbidity of the procedure.

What Are the Types and Frequencies of Complications Associated With Mandibular Third Molar Coronectomy? A Follow-Up Study.

PURPOSE: Coronectomy has been proposed for impacted third molars in close proximity to the inferior alveolar nerve (IAN) to avoid neurologic injury. Immediate (up to 1 month) and late (2 to 36 months) postoperative complications were investigated. MATERIALS AND METHODS: A prospective cohort study was performed on healthy patients treated in the dental clinic of the Department of Oral Surgery, University of Bologna. The predictor variables examined were experience of the surgeon (<10 vs ≥10 yr), length of surgery, type of mandibular third molar inclusion, and patient age. To assess the rate of postoperative complications, outcome variables were neurologic injuries, postoperative pain, swelling, fever, alveolitis, pulpitis, and root exposure. The success rate and need for a second surgery also were investigated. Univariate and bivariate descriptive statistics, Kaplan-Meier analysis, and Cox hazards modeling were performed to evaluate the variables. RESULTS: The study involved 94 healthy patients (mean age, 28.99 ± 8.9 yr; range, 17 to 56 yr; 37 men and 57 women) who had 116 third mandibular molars treated with coronectomy. During the 3-year follow-up period, 28 patients (29 coronectomy procedures) dropped out of the study. There was no case of neurologic injury to the inferior alveolar nerve (IAN) or to the lingual nerve (LN). In total, 30 complications were observed (25 within 1 month; 5 at 2 to 12 months). Surgeons with less than 10 years of training exposed patients to a greater risk of complications (hazard ratio = 2.069; 95% confidence interval, 1.004-4.263). An overall success rate of 74% at 6 months was estimated, and a second surgery was needed in 6% of cases. Of the retained roots analyzed, 80% showed postoperative root migration. CONCLUSIONS: In this study, coronectomy of mandibular third molars did not result in temporary or permanent injury to the IAN or LN. Coronectomy showed a low rate of postoperative complications. However, within the first year, a second surgery was needed in 6% of coronectomy procedures to remove migrated root fragments. Additional studies with larger patient samples are recommended to further investigate differences in postoperative complications in relation to patient age.

Assessment of perioperative, early, and late postoperative complications of the inside-out transobturator tape procedure in the treatment of stress urinary incontinence..

OBJECTIVE: To evaluate the complications of urinary incontinence surgery with transobturator tape (TVT-O) system and to describe its diagnosis and management. MATERIALS AND METHODS: A total of 156 patients who were diagnosed as having stress incontinence and mixed incontinence with stress predominance underwent a TOT operation under spinal anesthesia by one surgeon or two surgeons (MB, AEY) from the team. TVT-obturator inside out material was used in the operation. Urodynamic tests and pad tests were done on all the patients. This is a prospective and retrospective study of the complications of TVT-O. The operation was performed under regional anesthesia, as described by Deval et al. Patients were excluded from the study if they had been operated under general or local anesthesia, had undergone any vaginal operations except for anterior repair (cystocele), wanted to have a baby, had severe systemic diseases or had been diagnosed as having urge incontinence in urodynamic tests. These situations may affect the rate of complications, the authors also excluded slings that had materials other than monofilament polypropylene, and patients who were suspected of having neurologic bladder conditions. The bladder and urethra were evaluated using cystoscopy. The durations of the TOT procedure, cystoscopy, and if performed, the cystocele operation, were recorded. Perioperative, early, and late postoperative complications were analyzed by follow-up visits (after two months to four years). RESULTS: Of the 156 patients included in the study, 100 (64.1%) had pure stress urinary incontinence and 56 (35.9%) had mixed incontinence, 20 (12.8%) had previous incontinence surgery. The mean duration of follow up was 30.3 ± 7.4 (range 17-42) months. The mean age of the patients was found to be 48.43 ± 6.24 years (range 42-68). The mean parity of the patients was 5.24 ± 2.86 (range 2-13), and mean body mass index was found to be 23.7 ± 4.8. Mean maximum detrusor pressure was 10.30 ± 4.08 and the mean ALP value was 80.80 ± 25.57. Mean operative time was found to be 13.8 ± 5.16 min in patients who underwent only TOT and TOT-anterior repair. Vaginal injury including to the lateral fornix (4.4%), hemorrhaging of more than 200 ml (3.2%), vascular damage (1.9%), hematoma on the leg (1.9%), hemorrhaging of more than 500 ml (0.064%), and bladder perforation (1.2%) were detected as perioperative complications. Urethral injury and perioperative nerve and intestinal injury did not occur. The most common complication in early postoperative period was inguinal pain extending the legs (30.7%), followed by headaches (23.7%), fever (12.8%), urinary tract infection (5.7%), and urinary retention (3.2%), respectively. Late postoperative complications included vaginal erosion (4.4%), de novo urge incontinence (8.9%), de novo dyspareunia (7.1%), perineal pain (4.4%), and worsening urgency (8.9%). CONCLUSION: Although the TVT-O technique is a minimal invasive surgery method applied to treat the urinary incontinence surgically, it does not imply that it is a complication-free surgical procedure. Despite the low incidence of intraoperative complications, there is a mild risk of early and late postoperative complications. Fortunately these complications can be taken under control by either conservative and simple medical treatments or surgical procedures.

Evaluation of reconstructive techniques for anterior and middle skull base defects following tumor ablation.

PURPOSE: Reconstruction after resection of head and neck cancer can be challenging, especially when tumors extend to the base of the skull. Vascularized flaps are the option of choice, whether free or pedicled. Free flaps have the added benefit of access to the more cephalad defects of the anterior cranial base without the constraints of the rotation arc of pedicled flaps. The authors compared various flaps used for the reconstruction of defects of the anterior or middle skull base after resection of malignant tumors. MATERIALS AND METHODS: The authors identified 12 patients in whom 14 flaps were performed. All patients had malignant neoplasms extending to the anterior or middle cranial base that were reconstructed with free or pedicled flaps. A retrospective analysis was performed to compare the characteristics of patient demographics, tumor, and surgical technique. Complications among the various flaps were compared. Patients' assessments of function and quality of life were assessed by conducting a telephone survey. RESULTS: Most patients had stage 3 or 4 squamous cell carcinoma originating in the paranasal sinuses and extending to the anterior or middle skull base, requiring orbital exenteration. The flaps used included 6 radial forearm free flaps (RFFFs), 3 anterolateral thigh flaps (ALTs), 4 thoracodorsal artery perforator free flaps (TDAPs), and 1 pedicled supraclavicular flap. There were no major complications, such as perioperative heart attack, stroke, death, or meningitis. Minor complications included 3 mesh exposures after radiation treatment, 1 wound infection, and 2 flaps with wound dehiscence after radiation. These 2 dehiscences were seen with RFFFs and were later reoperated using TDAPs. There were no cerebrospinal fluid leaks or donor-site morbidity. There were no complaints of functional deficits, such as feeding difficulties or speech impairments. Some visual disturbance was reported after orbital exenteration, although this was an expected outcome. CONCLUSIONS: Vascularized flaps provide reliable and durable reconstructive options for anterior and middle skull base defects after resection of large complex malignant neoplasms of the craniofacial region. Free flaps, such as RFFFs, ALTs, and TDAPs, are well suited for these defects. They have a low risk of complications and low donor-site morbidity and offer good functional and esthetic outcomes.

[Short- and long-term results of various methods of reconstruction of carotid artery bifurcation].

AIM: comparative assessment of immediate and remote outcomes of various methods of reconstruction of the zone of bifurcation of the common carotid artery in stenotic lesions. MATERIAL AND METHODS: the authors carried out retrospective and prospective analysis of a total of 457 reconstructive operations on the bifurcation of the common carotid artery in 432 patients presenting with haemodynamically significant stenoses. Depending on the type of reconstruction of the carotid artery bifurcation, the patients were subdivided into four groups: group I - eversion carotid endarterectomy (CEA) - 157 (34.4%) operations, group II - CEA with xenopericardial patch plasty - 211 (46.2%) operations, group III- CEA with polytetrafluoroethylene (PTFE) patch plasty - 61 (13.3%) operations, group IV - CEA with original autoarterial remodelling of the bifurcation of the common carotid artery - 28 (6.1%) operations. We evaluated both immediate and remote (from 6 month to 4 years) results of surgical treatment. RESULTS: clinical efficacy of carotid endarterectomy in prevention of ischaemic stroke in the remote period after surgery amounted to 97.8%. Strokes developed in 2.2% of cases. It was shown that after using a xenopericardium patch the incidence rate of the development of restenosis proved statistically significantly lower than after using a PTFE patch. It was confirmed that CAE with autoarterial remodelling of the common carotid artery bifurcation or eversion CEA are accompanied by a significantly lower incidence rate of restenosis development in remote terms of follow up as compared to the methods of CAE with xenopericardial or PTFE patches (p<0.01). It was determined that coronary revascularization carried out by indications as the first stage statistically significantly decreases the incidence rate of acute myocardial infarction both in the immediate and remote terms of follow up after CEA.

[15-year experience with PTFE-grafts "Ecoflon" in Leriche s syndrome].

Analyzed herein are the outcomes of 1,079 reconstructions of the aortofemoral segment, performed for Leriche s syndrome using polytetrafluoroethylene grafts "Ecoflon" during the period from 1997 to 2012. Hospital lethality amounted to 3.1%, frequency of thromboses was 0.53% and that of amputations equalled 0.53%. The patients were followed up at terms varying from 6 to 180 months. Cumulative patency of the bypass grafts at 1 year amounted to 99.3±0.2%, at 5 years to 97.3±0.6%, at 10 year to 91.9±1.9%, and to 90.0±2.7% after 15 years. Primary patency amounted to 97.6±0.4%, 90.9±1.1%, 75.9±2.7% and 71.4±4.1%, respectively. Grafts infection occurred in 1.3% of cases (0.2% in the early, and 0.83% in the remote postoperative periods). False aneurysms of distal anastomoses were registered in 0.5% of cases. A total of 137 reoperations were performed (104 for graft thromboses, 9 for pseudoaneurysms of anastomoses, and 7 for graft infection). Seventeen operations were carried out for ischaemia relapse due to progression of the occluding process in patent grafts. The amputation rate amounted to 6.6%. Based on the obtained findings a conclusion is drawn that polytetrafluoroethylene grafts "Ecoflon" comply with the current standards of quality.

Evaluation of total laparoscopic hysterectomy with and without the use of barbed suture.

OBJECTIVE: To evaluate the outcome of total laparoscopic hysterectomy with and without the use of barbed suture. METHODS: We conducted a retrospective study among patients who underwent total laparoscopic hysterectomy between February 2008 and August 2012. The parameters evaluated were age, BMI, operative time, hospital stay, pre- and postoperative hemoglobin levels, uterine weight, intraoperative blood loss, and postoperative complications. RESULTS: A total of 202 women underwent total laparoscopic hysterectomy; barbed suture (V-Loc) was used in 63 women, and polydioxanone (PDS) in 139. Estimated blood loss, difference in hemoglobin level before and after surgery, operative time, and the duration of hospital stay were comparable between the two groups of patients. The incidence of postoperative fever was higher in the V-Loc group than in the PDS group (P = 0.003). Multiple linear regression analysis showed that the incidence of postoperative fever was related to BMI (P = 0.02, r = 0.22) and estimated blood loss (P = 0.004, r = 0.28) and not to age, operative time, or uterine weight. CONCLUSION: The use of barbed suture to close the vaginal vault after laparoscopic hysterectomy, compared with standard suture, results in similar operative time, blood loss, and duration of hospital stay. The use of barbed suture is technically less demanding than the use of regular sutures.

Objectif : Évaluer l'issue de l'hystérectomie laparoscopique totale, avec ou sans utilisation de sutures barbelées. Méthodes : Nous avons mené une étude rétrospective auprès de patientes ayant subi une hystérectomie laparoscopique totale entre février 2008 et août 2012. Les paramètres évalués étaient l'âge, l'IMC, la durée opératoire, le séjour à l'hôpital, les taux d'hémoglobine préopératoire et postopératoire, le poids utérin, la perte sanguine peropératoire et les complications postopératoires. Résultats : Au total, 202 femmes ont subi une hystérectomie laparoscopique totale; une suture barbelée (V-Loc) a été utilisée chez 63 femmes, tandis qu'une suture polydioxanone (PDS) a été utilisée chez les 139 autres femmes. La perte sanguine estimée, la différence entre le taux d'hémoglobine constaté avant la chirurgie et celui qui est constaté après celle-ci, la durée opératoire et la durée du séjour à l'hôpital étaient comparables dans les deux groupes de patientes. L'incidence de la fièvre postopératoire était plus élevée au sein du groupe « V-Loc ¼ qu'au sein du groupe « PDS ¼ (P = 0,003). L'analyse de régression linéaire multiple a indiqué que l'incidence de la fièvre postopératoire était liée à l'IMC (P = 0,02, r = 0,22) et à la perte sanguine estimée (P = 0,004, r = 0,28), mais non à l'âge, à la durée opératoire ou au poids utérin. Conclusion : L'utilisation d'une suture barbelée pour fermer le dôme vaginal à la suite d'une hystérectomie laparoscopique donne lieu à des résultats semblables à ceux de l'utilisation d'une suture standard en ce qui concerne la durée opératoire, la perte sanguine et la durée du séjour à l'hôpital. L'utilisation d'une suture barbelée est moins exigeante sur le plan technique que l'utilisation de sutures régulières.

[Complications and pitfalls by bone augmentation of maxillary sinus floor].

The article includes description of mistakes and complications occurring during sinus floor elevation procedure, in early post-operate period or late post-operate period. Recommendations have been made to eliminate and prevent their occurrence. The review summarizes data of Russian and foreign literature and our own clinical experience. Conclusions and practical recommendations for doctors have been formed based on the analysis of that data.

The IUGA/ICS classification of complications of prosthesis and graft insertion: a comparative experience in incontinence and prolapse surgery.

INTRODUCTION AND HYPOTHESIS: This is a presentation of case series after the use of alloplasic material in urogynaecology. METHODS: From 2004 to 2010, a total 179 patients with complications have been referred directly after the use of alloplastic material in incontinence and prolapse surgery. Of this total, 125 patients had a previous vaginal sling plasty because of urinary stress incontinence, while 54 patients underwent a prolapse surgery with mesh use. Symptoms and findings are expressed by the recently introduced International Urogynecological Association/International Continence Society (IUGA/ICS) terminology. RESULTS: The most frequent findings after vaginal sling plasty were bladder outlet obstruction, pain and tape exposure. The most frequent findings after prolapse surgery were pain and mesh erosion. The IUGA/ICS classification does not give the possibility to express functional disorders. Most revisions were done more than 2 months after surgery. After incontinence surgery, mostly the vaginal area of suture line was affected; after prolapse surgery, the vagina and the trocar passage were affected. CONCLUSIONS: Mesh complication and affected site after prolapse surgery do differ from those after incontinence surgery. The IUGA/ICS classification of mesh complication facilitates the comparison of mesh complication.

National hardware removal rate associated with internal fixation of facial fractures.

PURPOSE: There has not been a broad national examination of complications and demographics of facial trauma reduction procedures. The literature has reported acceptable and unacceptable hardware removal rates in localized populations. MATERIALS AND METHODS: The 2007 Nationwide Inpatient Sample was used to determine all plate removal procedures associated with common complications from facial reductions. Statistical analysis was used to compare the differences in demographics of the reduction procedure and removal procedure groups. RESULTS: Some form of open fixation was reported in 4,879 patients. Plate removals associated with complications were reported in 246 patients. The "failure" removal rate as a percentage of the total number of open procedures for the year was 5.0%. Gender, race, age, primary payer, and median income of the patient were determined to significantly affect the likelihood for hardware removal due to complications. CONCLUSION: These results suggest that decreased lower bone quality and ability to pay affect the chances that a particular patient will undergo a hardware removal procedure. There is a strong possibility that the reported removal rate underestimates the actual failure rate of the procedures and devices used to treat facial trauma.

Clinical classification of complications in guided bone regeneration procedures by means of a nonresorbable membrane.

The goal of classifying complications in guided bone regeneration procedures with nonresorbable membranes is to provide the clinician with an instrument for easier identification of both the problem and treatment modality. A standardized terminology represents a key point for proper communication among clinicians and provides guidelines for managing these drawbacks.

A nine-year review of orthognathic surgery at the University of Otago.

OBJECTIVE: To describe the demographic characteristics of patients undergoing orthognathic surgery at the University of Otago over a nine-year period. METHODS: The case notes of patients who underwent orthognathic surgery procedures at the University of Otago from 2001 to 2009 were reviewed retrospectively. This was augmented with a brief literature review of surgical considerations and complications in orthognathic surgery among older patients. RESULTS: The 92 patients included in the study were aged 15 to 56 years. The mean patient age increased over the nine-year observation period, from 22.1 years (sd, 9.4) during 2001-2003, 25.0 years (sd, 12.7) during 2004-2006, to 27.7 years (sd, 11.4) during 2007-2009. Most patients were from New Zealand European or European backgrounds, with only 5.5% identifying as Maori, and 3.3% as Asian. A female preponderance was observed (with a female:male ratio of 1.6:1). Complications were encountered with 24 patients (26.1%). Ten patients had long-term (lasting for one year or more) sensory nerve disturbance; all of those had undergone a mandibular bilateral sagittal split osteotomy (BSSO) procedure (they comprised 12.7% of all BSSO patients treated); half of those patients were over 35 years old, and four were over 40 years old. CONCLUSIONS: There has been an increase in the proportion of older patients undergoing orthognathic surgery at the University of Otago. Observations from this case series support findings from other studies demonstrating a higher rate of sensory nerve disturbance among older BSSO patients.

[Complications after reconstructive implantation of silicone endoprostheses in patients with breast cancer].

Radical mastectomy, though is considered to be the main method of the breast cancer treatment, influences the physical and psychological rehabilitation of patients extremely negatively. Reconstructive silicone endoprosthesing alternates radical mastectomy. Complications of the procedure analysed using the experience of 120 women with breast cancer. The on-time detection of complications drastically improves long-term aesthetic results.

Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems.

AIMS: This aim of this study was to assess the reliability and validity of the Unified Classification System (UCS) for postoperative periprosthetic femoral fractures (PFFs) around cemented polished taper-slip (PTS) stems. METHODS: Radiographs of 71 patients with a PFF admitted consecutively at two centres between 25 February 2012 and 19 May 2020 were collated by an independent investigator. Six observers (three hip consultants and three trainees) were familiarized with the UCS. Each PFF was classified on two separate occasions, with a mean time between assessments of 22.7 days (16 to 29). Interobserver reliability for more than two observers was assessed using percentage agreement and Fleiss' kappa statistic. Intraobserver reliability between two observers was calculated with Cohen kappa statistic. Validity was tested on surgically managed UCS type B PFFs where stem stability was documented in operation notes (n = 50). Validity was assessed using percentage agreement and Cohen kappa statistic between radiological assessment and intraoperative findings. Kappa statistics were interpreted using Landis and Koch criteria. All six observers were blinded to operation notes and postoperative radiographs. RESULTS: Interobserver reliability percentage agreement was 58.5% and the overall kappa value was 0.442 (moderate agreement). Lowest kappa values were seen for type B fractures (0.095 to 0.360). The mean intraobserver reliability kappa value was 0.672 (0.447 to 0.867), indicating substantial agreement. Validity percentage agreement was 65.7% and the mean kappa value was 0.300 (0.160 to 0.4400) indicating only fair agreement. CONCLUSION: This study demonstrates that the UCS is unsatisfactory for the classification of PFFs around PTS stems, and that it has considerably lower reliability and validity than previously described for other stem types. Radiological PTS stem loosening in the presence of PFF is poorly defined and formal intraoperative testing of stem stability is recommended. Cite this article: Bone Joint J 2021;103-B(8):1339-1344.

Association of malnutrition with postoperative complication risk after curative surgery for oral cancer: Observational study.

ABSTRACT: Malnutrition is common among patients who have oral cavity squamous cell carcinoma (OSCC), but its effect on the incidence of postoperative complications remains uncertain. Validated nutrition and complication assessment tools were used to evaluate the effects of nutrition on the likelihood of postoperative complications after curative surgery for OSCC.A retrospective study that spanned January 2014 to December 2018 enrolled 70 patients who received curative surgery for OSCC. Nutritional status before surgery was evaluated with the scored Patient-Generated Subjective Global Assessment (PG-SGA), and patients were classified as either well-nourished (rating A) or malnourished (ratings B and C). Complications 30 days after the operation were graded using Clavien-Dindo classification. The perioperative clinicopathological characteristics of the groups were compared, and risk factors for postoperative complications were identified through logistic regression.A total of 44 (62.8%) patients formed the malnourished group, and they tended to be older (P = .03), weigh less (P = .001), have lower Body Mass Index (P = .003), higher PG-SGA scores (P < .001), higher neutrophil-to-lymphocyte ratio (P = .034), more postoperative complications (P < .001), and longer hospital stays (P = .021). Major complications (Clavien-Dindo classification ≥ IIIa) were experienced by 18.5% (n = 13) of patients and were more common in the malnourished group (P = .007). Multivariate logistic regression demonstrated that PG-SGA score ≥4 was an independent risk factor for postoperative complications (hazard ratio = 4.929, P = .008).Malnutrition defined using the PG-SGA is an independent risk factor for postoperative complications of curative surgery in patients with OSCC. More prospective studies are warranted to confirm our findings.

Skeletal stability and complications of bilateral sagittal split osteotomies and mandibular distraction osteogenesis: an evidence-based review.

PURPOSE: To provide an evidence-based review comparing the skeletal stability and complications of bilateral sagittal split osteotomies (BSSOs) and mandibular distraction osteogenesis (MDO) in the treatment of mandibular hypoplasia. MATERIALS AND METHODS: A Medline search from January 1957 to December 2007 was performed wherein articles were retrieved on the basis of a set of inclusion and exclusion criteria. Data on mean skeletal stability and complications for the 2 techniques were retrieved from these articles. RESULTS: Based on the articles about stability, patients undergoing BSSO or MDO with an advancement or lengthening between 6 and 10 mm showed a similar mean skeletal relapse of 15.0% and 17.1%, respectively, within postoperative months 6 to 12. Greater skeletal relapse was reported for BSSO patients with high mandibular plane angles compared with normal mandibular plane angle patients (29.6% vs 11.3%). Based on the articles about complications, patients who underwent MDO showed a lower incidence of persistent inferior alveolar nerve disturbance (2.9%) and condylar resorption (1.4%) compared with BSSO patients, in whom the incidence of these conditions was 27.8% and 6.1%, respectively. CONCLUSION: Both BSSO and MDO showed similar relapse rates for mandibular advancements between 6 and 10 mm. Both techniques may also share similar risk factors for skeletal relapse. BSSO has a higher incidence of persistent neurosensory disturbances and condylar resorption than MDO. Randomized controlled trials of these 2 techniques are still lacking.