Non-grafted versus grafted sinus lift procedures for implantation in the atrophic maxilla: a systematic review and meta-analysis of randomized controlled trials.

The aim of this systematic review and meta-analysis was to critically evaluate the currently existing clinical evidence on the efficacy of graftless maxillary sinus membrane elevation for implantation in the atrophic posterior maxilla. A search protocol without limitations to November 2020 was followed by two independent researchers. Randomized controlled trials using the lateral window approach for graftless sinus membrane elevation were included. Uncontrolled, retrospective, non-comparative studies, case reports, and experimental studies in animals or cadavers were excluded. The search identified 2777 studies. Critical selection by two independent researchers then led to the inclusion of a total of nine studies. A risk of bias assessment was applied using the revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis was conducted for seven studies. Results showed a high overall implant survival rate in both the graftless and bone-grafted sinus lift groups (97.92% and 98.73%, respectively). The graftless sinus lift group showed a significantly lower vertical bone height gain, with a mean difference of -1.73mm (P=0.01), and a significantly lower bone density, with a mean difference of -94.7 HU (P<0.001). The implant stability quotient values did not differ significantly between the test and control groups (P=0.07).

Acetone clearance of mesocolic or mesorectal fat increases lymph node yield and may improve detection of high-risk Stage II colorectal cancer patients.

AIM: Lymph node (LN) status is key to determining the need for adjuvant therapy in colorectal cancer (CRC) and for disease which has progressed to Stage II (T3-T4, N0, M0). A yield of fewer than 12 LNs is considered a risk factor similar to high-grade histology and vascular, lymphatic and perineural invasion. The aim of this retrospective study was to investigate the effect of acetone fat clearance of the mesocolon or mesorectum on LN yield and the identification of patients with high-risk Stage II CRC. METHOD: After conventional LN retrieval, fatty tissue derived from the mesocolon or mesorectum of 80 CRC specimens was incubated in acetone for 24 h. A second dissection was then performed by a trained technician. The total number of LNs as well as tumour involvement (LNpositive and LNnegative) were assessed at each stage. In addition, LN morphology was assessed and clinicopathological data were extracted from existing pathology reports. RESULTS: Eighty CRC specimens were available for study. 1548 (94%) LN were negative and 96 (6%) were positive. The median (range) LN yield per specimen was 12 (3-41) LN increasing to 18 (4-48) LN after fat clearance (P < 0.001). After fat clearance, 534 additional LNs were identified in 75 (94%) of the specimens, and all but 10 were negative. The pN stage did not change in six patients who were found to be LN positive after fat clearance. However, the number of high-risk Stage II CRC patients decreased from 11 to 7. Although important for these patients, this downstaging did not reach statistical significance (P = 0.125). CONCLUSION: Acetone clearance of mesocolic or mesorectal fat increases median LN yield and may in a larger study decrease the number of patients classified as having high-risk Stage II CRC.

Een jongen met een rode, gezwollen wang.

A 7-year-old boy was referred to the paediatric clinic with a swollen cheek since one day. Intraoral examination revealed erythematous and swollen gingivae in the right upper quadrant. The consulted maxillofacial surgeon diagnosed him with a canine fossa abscess. The patient recovered quickly after incision and drainage, followed by antibiotic therapy.