The correlation between the quality of oral hygiene and oral HPV infection in adults: a prospective cross-sectional study.

OBJECTIVES: Various risk factors for oral human papillomavirus (HPV) infections have been described, including tobacco smoking and sexual behavior. However, less is known about the influence of oral health on such infections. The present study aimed to determine a possible association between the quality of oral hygiene and the presence of oral HPV. METHODS: In a prospective analysis, the approximal plaque index (API), the gingival bleeding index (GBI), and the lifetime number of extracted teeth was determined in 187 patients. Additionally, the presence of oral low-risk and/or high-risk HPV was investigated by brush smear testing in all participants. RESULTS: Seventy-four patients had an API < 20%, 84 participants showed an API of 20-40%, and in 29 cases, an API > 40% was recorded. Ninety-six patients presented a GBI < 20%, 75 had a GBI of 20-40%, and 16 showed a GBI > 40%. One hundred four patients had experienced one to three extractions, and 36 had lost more than three teeth. Thirty-nine participants had a positive oral HPV testing (27 high-risk HPV, 26 low-risk HPV, 14 low- and high-risk HPV). A higher API respectively GBI and a greater number of extracted teeth were significantly correlated with the presence of high-risk HPV. The presence of low-risk HPV was significantly higher in patients with API > 40% and GBI > 40% (OR 7.89). Similar results were found regarding the number of extracted teeth. CONCLUSION: The present analysis confirms a relationship between the quality of oral hygiene, determined by objective markers. Thus, improvement of oral health may reduce the incidence of oral HPV infection. CLINICAL SIGNIFICANCE: The present article investigates the relationship between oral hygiene and the presence of oral HPV. As a significant correlation between these two factors could be recorded, improvement of oral hygiene may reduce actively the incidence of oral HPV. Thereby, good oral hygiene may contribute oral cancer prevention.

Long-term influence of mandibular advancement on the volume of the posterior airway in skeletal Class II-patients: a retrospective analysis.

In the past, maxillomandibular advancement has resulted in considerable improvement in the volume of the posterior airway space. The objective of the present study was to find out how mandibular advancement without maxillary involvement would affect the posterior airway space in patients with mandibular retrognathism. Cone-beam computed tomographic (CT) scans were done for 20 patients before, and six months after, mandibular advancement. Cephalometric analysis at both time points included 2-dimensional and 3-dimensional assessment of the upper airway. Eight men and 12 women presented a preoperative mean (SD) Wits value of 7.4 (1.54) mm, with an airway area of 7.11 (1.88) cm2 and a volume of 14.92 (4.46) cm3. Six months postoperatively they showed a Wits value of 2.7 (0.41) mm, an airway area of 11.33 (3.49) cm2, and a volume of 25.7 (6.10) cm3. There was a mean (range) enlargement of 59 (22-82) % of the area and 73 (29-108) % of the volume. A preoperative Wits value of 8mm or more correlated significantly with a larger increase of the posterior airway space (p=0.002). At the same time, an improvement in the Wits value of 4.5mm or more correlated significantly with an increase in volume (p=0.016). The effect of mandibular advancement on the posterior airway space was significant, and the volumetric effect seems to be even more relevant than the two-dimensional changes.

Influence of Ultra-Low-Dose and Iterative Reconstructions on the Visualization of Orbital Soft Tissues on Maxillofacial CT.

BACKGROUND AND PURPOSE: Dose reduction on CT scans for surgical planning and postoperative evaluation of midface and orbital fractures is an important concern. The purpose of this study was to evaluate the variability of various low-dose and iterative reconstruction techniques on the visualization of orbital soft tissues. MATERIALS AND METHODS: Contrast-to-noise ratios of the optic nerve and inferior rectus muscle and subjective scores of a human cadaver were calculated from CT with a reference dose protocol (CT dose index volume = 36.69 mGy) and a subsequent series of low-dose protocols (LDPs I-4: CT dose index volume = 4.18, 2.64, 0.99, and 0.53 mGy) with filtered back-projection (FBP) and adaptive statistical iterative reconstruction (ASIR)-50, ASIR-100, and model-based iterative reconstruction. The Dunn Multiple Comparison Test was used to compare each combination of protocols (α = .05). RESULTS: Compared with the reference dose protocol with FBP, the following statistically significant differences in contrast-to-noise ratios were shown (all, P ≤ .012) for the following: 1) optic nerve: LDP-I with FBP; LDP-II with FBP and ASIR-50; LDP-III with FBP, ASIR-50, and ASIR-100; and LDP-IV with FBP, ASIR-50, and ASIR-100; and 2) inferior rectus muscle: LDP-II with FBP, LDP-III with FBP and ASIR-50, and LDP-IV with FBP, ASIR-50, and ASIR-100. Model-based iterative reconstruction showed the best contrast-to-noise ratio in all images and provided similar subjective scores for LDP-II. ASIR-50 had no remarkable effect, and ASIR-100, a small effect on subjective scores. CONCLUSIONS: Compared with a reference dose protocol with FBP, model-based iterative reconstruction may show similar diagnostic visibility of orbital soft tissues at a CT dose index volume of 2.64 mGy. Low-dose technology and iterative reconstruction technology may redefine current reference dose levels in maxillofacial CT.

The impact of sexual behavior on oral HPV infections in young unvaccinated adults.

OBJECTIVE: Different authors hypothesized an important impact of sexual behavior on the prevalence of oral human papillomavirus (HPV) infections. In order to investigate this relationship more in detail and in contrast to most other studies, the present work focused on the population group with the highest risk for sexually transmitted infections: young and sexual active adults. MATERIALS AND METHODS: Three hundred and ten men and women aged 18-30 years could be recruited. After the completion of a risk-factor survey, brush smear samples for oral HPV detection were taken in every participant. RESULTS: In 18.1 %, oral HPV could be detected. Overall, smoking (p = 0.0074) and a high number of different sexual partners (vaginal: p = 0.0001; oral: p < 0.0001) were significantly correlated with a positive HPV testing. In case of high risk HPV infections, besides tobacco and sexual behavior, alcohol consumption showed a significant association with a positive testing (p = 0.0212). CONCLUSIONS: Overall, the prevalence of oral HPV seems to be higher in young, sexual active adults compared to other population groups. Tobacco and alcohol may facilitate an oral HPV infection. Sexual behavior, especially oral sex practices, seems to play a crucial role in the transmission of oral HPV. CLINICAL RELEVANCE: The presented data, especially the association of oral high risk HPV positivity and promiscuity, may lead to improvements in the existing oral HPV prevention strategies like a HPV vaccination for both genders.

Ultralow-dose computed tomography imaging for surgery of midfacial and orbital fractures using ASIR and MBIR.

The influence of dose reductions on diagnostic quality using a series of high-resolution ultralow-dose computed tomography (CT) scans for computer-assisted planning and surgery including the most recent iterative reconstruction algorithms was evaluated and compared with the fracture detectability of a standard cranial emergency protocol. A human cadaver head including the mandible was artificially prepared with midfacial and orbital fractures and scanned using a 64-multislice CT scanner. The CT dose index volume (CTDIvol) and effective doses were calculated using application software. Noise was evaluated as the standard deviation in Hounsfield units within an identical region of interest in the posterior fossa. Diagnostic quality was assessed by consensus reading of a craniomaxillofacial surgeon and radiologist. Compared with the emergency protocol at CTDIvol 35.3 mGy and effective dose 3.6 mSv, low-dose protocols down to CTDIvol 1.0 mGy and 0.1 mSv (97% dose reduction) may be sufficient for the diagnosis of dislocated craniofacial fractures. Non-dislocated fractures may be detected at CTDIvol 2.6 mGy and 0.3 mSv (93% dose reduction). Adaptive statistical iterative reconstruction (ASIR) 50 and 100 reduced average noise by 30% and 56%, and model-based iterative reconstruction (MBIR) by 93%. However, the detection rate of fractures could not be improved due to smoothing effects.

Substantial dose reduction in modern multi-slice spiral computed tomography (MSCT)-guided craniofacial and skull base surgery.

PURPOSE: Reduction of the radiation exposure involved in image-guided craniofacial and skull base surgery is an important goal. The purpose was to evaluate the influence of low-dose protocols in modern multi-slice spiral computed tomography (MSCT) on target registration errors (TREs). MATERIALS AND METHODS: An anthropomorphic skull phantom with target markers at the craniofacial bone and the anterior skull base was scanned in Sensation Open (40-slice), LightSpeed VCT (64-slice) and Definition Flash (128-slice). Identical baseline protocols (BP) at 120  kV/100  mAs were compared to the following low-dose protocols (LD) in care dose/dose modulation: (LD-I) 100  kV/35ref. mAs, (LD-II) 80  kV/40 - 41ref. mAs, and (LD-III) 80  kV/15 - 17ref. mAs. CTDIvol and DLP were obtained. TREs using an optical navigation system were calculated for all scanners and protocols. Results were statistically analyzed in SPSS and compared for significant differences (p ≤ 0.05). RESULTS: CTDIvol for the Sensation Open/LightSpeed VCT/Definition Flash showed: (BP) 22.24 /32.48 /14.32 mGy; (LD-I) 4.61 /3.52 /1.62 mGy; (LD-II) 3.15 /2.01 /0.87 mGy; and (LD-III) na/0.76 /0.76 mGy. Differences between the BfS (Bundesamt für Strahlenschutz) reference CTDIvol of 9 mGy and the lowest CTDIvol were approximately 3-fold for Sensation Open, and 12-fold for the LightSpeed VCT and Definition Flash. A total of 33 registrations and 297 TRE measurements were performed. In all MSCT scanners, the TREs did not significantly differ between the low-dose and the baseline protocols. CONCLUSION: Low-dose protocols in modern MSCT provided substantial dose reductions without significant influence on TRE and should be strongly considered in image-guided surgery.

Medial tongue cleft associated with intraoral hamartoma--case report and review of literature.

A newborn female was referred with the following clinical symptoms: median tongue cleft, palate cleft, ankyloglosson, sublingual intraoral hamartoma and palatal intraoral hamartoma. Magnetic resonance imaging showed a subcutaneous cyst overlying the manubrium sterni. Genetic investigation (chromosome analysis) showed no aberrations and/or variations. The quick growth of the intraoral hamartoma required an excision at the age of 3 months. Under general anaesthesia the intraoral hamartoma was excised and the median tongue cleft was closed. Median tongue clefts are reported to be only associated with orofacial digital syndromes type I, II, IV and VI. If the clinical appearance is described without any association to an orofacial syndrome, the Tessier 30 cleft definition could be used as the best explanation of the symptoms. This is the first description of a combination of tongue cleft, palate cleft, intraoral hamartoma and subcutaneous cyst overlying the manubrium sterni. The clinical symptoms of this patient can be described best as a mild form of an orofacial digital syndrome type II or variation of a Tessier cleft No. 30.

[Management of mid-facial fractures]. / Versorgung von Mittelgesichtsfrakturen.

In the past, treatment of maxillofacial fractures was characterized by low incidences of midface fractures, while severe cases were associated with a high death rate. Over the last decades the application of new techniques has provided a successful outcome in the management of these more frequently observed injuries. With the introduction of antibiotics and the principles of modern anesthesiology, conservative methods of fracture treatment such as intermaxillary fixation and the application of extension devices were increasingly replaced by surgical techniques. The development of different osteosynthesis plate and screw systems in the early 1970s has made three-dimensional reconstruction a standard of care in the surgical treatment of midface fractures. With the recent introduction of commercially available bioresorbable systems, removal of osteosynthesis material has become an unnecessary procedure. Further research in innovative techniques of maxillofacial surgery and imaging, such as image-guided surgery by computer navigation, may be warranted to minimize surgical approaches and decrease incidences of perioperative morbidity.

Preoperative autologous blood donation in orthognathic surgery: a follow-up study of 179 patients.

Although there have been recent advances in maxillofacial surgery and anaesthetic techniques, blood replacement is still common in orthognathic surgery. 179 patients underwent elective orthognathic surgery and donated autologous blood preoperatively. Standardized questionnaires about the preoperative blood donation were distributed to the patients. Haemoglobin, haematocrit, red blood cells and platelets were measured before blood donation, presurgically and postsurgically, as well as one year after surgery. Nearly all patients (98%) would recommend preoperative autologous blood donation. 97% of the patients saw the benefits of autologous blood donation in avoiding transfusion-transmitted infectious diseases such as acquired immune deficiency syndrome (AIDS) and hepatitis. No serious side-effects have been observed after blood donation. In patients with bimaxillary osteotomies (65% of the predeposited autologous blood units) 41% were in cases having upper jaw osteotomies and only 22% of the preoperatively donated units were retransfused in patients having lower jaw osteotomies. After a postsurgical decrease, the mean haemoglobin and mean haematocrit levels regained the levels determined prior to the donation. Preoperative autologous blood donation of 2 to 3 units (900-1350 ml +/- 10%) of blood is recommended in bimaxillary osteotomies and 1 to 2 units (450-900 ml +/- 10%) of blood for upper jaw osteotomies. In lower jaw surgery, the acute isovolaemic haemodilution should be considered.

Femoral shaft reconstruction using tissue-engineered growth of bone.

Tissue engineering is an interdisciplinary field that applies the principles and methods of engineering and the life sciences to the development of biologic substitutes. Bovine periosteum-derived cells were cultivated in vitro, put onto bioresorbable polymer fiber constructs, and allowed to grow until most of the fibers were coated with multiple layers of osteoblasts. Standardized 9-mm nonhealing defects were created in 24 male athymic rats femurs and bridged with titanium miniplates. In 12 animals, the defects were filled with polymer constructs containing periosteum-derived cells (experimental group); in another 12 animals, the defects were either left unfilled (control group I) or filled with polymer templates alone (control group II). After 12-week in vivo implantation, the new bone produced bridged the surgically created defects completely in seven of 10 cases. The animals of the control groups did not show significant bone formation in the gap. Histologic evaluation revealed bone formation in all experimental specimens with rests of cartilage islands showing hypertrophying chondrocytes indicative of enchondral bone formation. Tissue-engineered growth of bone resulted in healing of large segmental bone defects in an orthotopic site in an animal model. The findings of this study support potential applications of the technique of tissue-engineered growth of bone to clinical situations where local bone formation is needed.

Temporomandibular joint disc replacement made by tissue-engineered growth of cartilage.

OBJECTIVE: To test the effectiveness of the new technique of tissue-engineered growth of cartilage, temporomandibular joint (TMJ) disc replacements were created by seeding dissociated chondrocytes on synthetic, three-dimensional, bioresorbable polymer constructs of a predetermined anatomic shape, incubating the cell-polymer constructs in vitro, and transplanting them into test animals. MATERIALS AND METHODS: Twelve highly porous and bioresorbable cell-transplantation devices in the shape of TMJ discs were created using biodegradable polylactid and polyglycolic acid fibers. Bovine articular cartilage was dissociated into chondrocytes and the cells were allowed to attach to the three-dimensional polymer scaffolds and multiply in vitro. After 1 week, the cell-polymer constructs were implanted subcutaneously into nude mice. The neocartilage was assessed by magnetic resonance imaging (MRI) techniques, gross inspection, histology, and biomechanical and biochemical analysis after 12 weeks. RESULTS: All implants seeded with chondrocytes showed gross evidence of histologically organized hyaline cartilage. The scaffolds maintained their specific shape. They not only showed appropriate intrinsic stability during neomorphogenesis of cartilage in vitro and in vivo, but also seemed to guide the growth of cartilage. The presence of sulfated glycosaminoglycans was shown by aldehyde fuchsin alcian blue staining of the specimens. Type II collagen, considered to be indicative of cartilage formation, was found in the specimens tested. MRI showed signal characteristics similar to those of hyaline cartilage. Analysis of neocartilage force/displacement curves and aqueous phase compliance using a closed compression chamber suggested that the ability of the constructs to resist deformation was similar to that of native donor cartilage. CONCLUSION: The technology of tissue-engineered growth of cartilage on individually designed scaffolds may have many applications not only in reconstructive surgery of the TMJ, but also in craniomaxillofacial, plastic, and orthopedic surgery.

Cartilage engineered in predetermined shapes employing cell transplantation on synthetic biodegradable polymers.

Cartilage is often used as structural support tissue for cosmetic repair in plastic and reconstructive surgery. We describe the efficacy of a new approach for the generation of cartilage in predetermined shapes using specially configured biodegradable synthetic polymer devices as delivery vehicles for transplanted cells. Synthetic biodegradable polymer scaffolds were configured in one of four specific shapes, i.e., a triangle, a rectangle, a cross, and a cylinder. The polymer matrices were seeded with freshly isolated bovine articular chondrocytes and then implanted subcutaneously into nude mice. Gross examination of excised specimens 12 weeks after implantation revealed the presence of new hyaline cartilage of approximately the same dimensions as the original construct. This cartilage showed no signs of resorption or overgrowth over the 12-week time course of the experiment. Histologic evaluation using hematoxylin and eosin stains confirmed the presence of normal mature hyaline cartilage in 46 of 48 specimens. These results suggest that cartilage can be created in predetermined shapes and dimensions using cell transplantation on appropriate polymer templates. This technology would be useful in cosmetic and reconstructive surgery.

Design of nasoseptal cartilage replacements synthesized from biodegradable polymers and chondrocytes.

Reconstructive and aesthetic surgery of the nose is a challenging problem in facial plastic surgery. In this study, biodegradable polymers composed of polyglycolic acid (PGA) and poly-L-lactic acid (PLLA) and their co-polymers were used to produce templates to transplant cells and promote regeneration of structural cartilage. A highly porous anatomically shaped three-dimensional non-woven PGA fibre network was sprayed with a coating polymer solution. Reinforcement of the outer circumference of the 12 nasoseptal constructs using high molecular weight PLLA further stabilized the constructs during the process of neomorphogenesis of cartilage, both during in vitro incubation and in vivo implantation. These cell transplantation devices also proved to be adhesive substrates for dissociated bovine chondrocytes. When implanted subcutaneously into nude mice, the polymer templates guided the reorganization after 8 wk of the bovine chondrocytes into neocartilage in the precisely designed size and shape of the original size and shape of the polymer delivery device. All implants loaded with chondrocytes showed evidence of formation of histologically organized hyaline cartilage. The implantation of nasal scaffolds without cells did not show cartilage formation. The technique of tissue engineered growth of cartilage has potential applications in orthopaedic, plastic and reconstructive, and craniomaxillofacial surgery.

Tissue-engineered growth of cartilage: the effect of varying the concentration of chondrocytes seeded onto synthetic polymer matrices.

Ninety-six synthetic bioresorbable cell-delivery devices (10 x 10 x 0.5 mm) were seeded, varying the concentrations of living chondrocytes (2, 10, 20, 100 million cells/cc) isolated from shoulders of freshly killed calves and implanted subcutaneously on the dorsum of nude mice after 1 week of in vitro culture. This resulted in the formation of new cartilage in 95.6% of the implants. Twenty-four control implants (0 cells seeded) did not show cartilage formation. During 12 weeks of in vivo implantation, the wet weight and the thickness of the specimens (10, 20, 100 million cells/cc) increased significantly. Histologic analysis revealed cells appearing in their own lacunar structures surrounded by basophilic matrix. The increase in sulfated glycosaminoglycan content indicated the maturation of the extracellular matrix. The ability to manipulate the growth of new cartilage on biocompatible polymer scaffolds by varying the cell density before in vivo implantation will allow engineering to optimize the utilization of chondrocytes in relation to the desired shape, thickness, and quality of the new cartilage.

[Reconstructive procedures for improving the facial contour]. / Rekonstruktive Massnahmen zur Verbesserung der Gesichtskontur.

From 1986 to 1992 in the Department of Oral and Maxillofacial Surgery in Innsbruck, in 102 patients with a congenital or acquired deformity of the face, 128 augmentations with Hydroxylapatite granules (in 36 cases) or with Ethylenoxid-sterilised lyophilised cartilage (in 92 cases) have been performed. Hydroxylapatite granules, filled in a Vicryl-tube and implanted subperiosteal solely, proved to be at well tolerated material and consistently in form. In different areas of the face implanted Ethylenoxid-sterilised lyophilised cartilage showed no loss of substance up to now.

Miniplate eminoplasty: a new surgical treatment for TMJ-dislocation.

UNLABELLED: The miniplate eminoplasty is a technically easy, extra-articular procedure for surgical treatment of TMJ-dislocation with a predictable functional result. OPERATIVE TECHNIQUE: A conventional preauricular incision is made. With the condyle in the therapeutic position the eminoplasty miniplate is inserted anterior to the articular eminence. The miniplate is fixed to the zygomatic arch with miniscrews in order to augment the articular eminence. No postoperative immobilization is required. Although muscular activity cannot be avoided after surgery, no recurrence of dislocation, fracture or loosening of the implants occurred. Results and examples are demonstrated.

[Sports-related maxillofacial trauma in young patients]. / Sportbedingte Gesichtsschädelverletzungen im Wachstumsalter.

314 young patients with sports-related maxillofacial trauma were classified into 34.7% facial fractures, 35.9% dentoalveolar trauma and 28.4% soft tissue injuries. In the alpine regions the distribution of fractures by aetiology is dominated by skiing accidents. 43% of the midface fractures are due to fractures of the zygomatic bone and arch. Children up to ten years are more prone to dentoalveolar trauma. Opportune preventive measures are recommended.

[AIDS--mucous membrane manifestations]. / AIDS--Schleimhautmanifestationen.

In the course of the infection with the human immunodeficiency virus (HIV), we frequently observe disorders of the mucous membranes and, occasionally, they present the first manifestation of HIV-induced immunodeficiency. Like in other organs, opportunistic infections and malignant tumors prevail as a result of the impaired immune system. Opportunistic infections are characterized by frequency (candidiasis), aggressive expansion, persistence, frequent recurrences, and resistance to therapy (gingivitis, parodontitis, herpes simplex, warts). Oral hairy leucoplakia is considered a specific lesion of HIV infection. Malignant tumors, such as Kaposi's sarcoma, non-Hodgkin's lymphoma, and squamous cell carcinoma, may cause marked morbidity in AIDS patients; occasionally, the clinical picture of Kaposi's sarcoma and non-Hodgkin's lymphoma is rather uncharacteristic. Other manifestations on the mucous membranes may arise in association with systemic reactions, such as drug eruptions, thrombocytopenic purpura, or acute HIV infection. The etiology of still other lesions of the mucous membranes (e.g. chronic recurrent ulcers, xerostomia, disorders of pigmentation) is incompletely understood. The awareness of these disorders of the mucous membranes in HIV infection is of diagnostic, therapeutic and epidemiological importance.