The Value of Surveillance Imaging of Oral Squamous Cell Carcinoma.

The evaluation of surveillance imaging of OSCC patients is a difficult task physicians have to face daily. Multiple patients experience a recurrence of this disease, which underlines the importance of regular patient monitoring programs. Our study analysed the value of surveillance imaging, such as computed tomography (CT) and nuclear magnetic resonance imaging (NMRI), as a patient monitoring programme and its effectiveness in achieving improvement in early recurrence detection. The study comprised 125 patients, out of which 56 (n = 56) showed radiological and 69 (n = 69) showed clinical and radiological conspicuous patterns in domestic follow-ups, respectively. The use of CT and NMRI showed a significant dependence on the histological result (p = 0.03). However, the different groups showed no significant dependence on the histological result (p = 0.96). The distribution of the histological biopsies, which were taken due to radiological changes, were prone to wrong positive diagnoses (false positives) in 71 percent. To conclude, imaging modalities should be chosen for each patient individually to reduce false positives, improve the early detection of recurrence, and increase the cure rate.

Perioperative anticoagulation in head and neck free flap reconstructions: Experience of an anticoagulative scheme and its modification.

OBJECTIVES: Microvascular anastomoses in microvascular reconstructions induce rheological changes in the anastomosed vessels and are usually counteracted by anticoagulative medication. There is no regimen commonly agreed on. This study provides an easy to use anticoagulative regimen. PATIENTS AND METHODS: Consecutive cases of either anticoagulative regimen between 2013 and 2018 that underwent microvascular reconstruction in the head and neck area were included in this retrospective study, resulting in 400 cases in total. Two different anticoagulative regimens were applied to 200 patients in each group: (a) intraoperatively administered unfractionated 5000 I.U. high molecular weight heparin (HMWH) and postoperatively low molecular weight heparin (LMWH, Enoxaparin) 1 mg/kg/body weight postoperatively and (b) intraoperatively LMWH 0.5 mg/kg/body weight as well as 12 h later and 1 mg/kg/body weight postoperatively. RESULTS: The LMWH cohort showed fewer overall thromboembolic (8.5% vs. 11%; p = .40) and peripheral thrombotic events (1% vs. 3.5%; p = .18) and lung embolisms (3% vs. 4%; p = .59). The number of thromboses at the site of the anastomosis was equally distributed. In regard to flap-specific complications, LMWH was associated with a positive effect, in particular with respect to total flap losses (5% vs. 7%; p = .40) and wound-healing disorders (14.5% vs. 20%; p = .145). CONCLUSION: Findings indicate that intra- and postoperatively administered LMWH as the only anticoagulative medication seems reliable in our clinical routine of head and neck free flap reconstructions.

The COVID-19 pandemic and its possible impact on the treatment of odontogenic and intraoral abscesses.

Most odontogenic and intraoral abscesses can be treated on an outpatient basis with local anesthesia. However, severe disease progression may require an incision under general anesthesia (GA) with postoperative inpatient treatment. This study aimed to evaluate the first "COVID-19 year" in Germany and compare the first "COVID-19 year" with the two previous years. All consecutive cases with odontogenic or intraoral abscesses treated in an outpatient or inpatient setting between 2018 and 2021 were included in this study. Data were collected, including the type of anesthesia, length of hospital stay, and healthcare costs. Despite the lower total number of abscess treatments in the first year of COVID-19 (n = 298 patients) than that in the two previous years (n = 663 patients), the number of advanced abscesses requiring intervention under GA was significantly higher (p < 0.001). This increased burden of care was also reflected in increased healthcare costs. The measures taken against the COVID-19 pandemic had an impact on the course of other diseases, for example, odontogenic and intraoral abscesses. The results showed an emerging conflict in patient care during the pandemic crisis that should be considered in possible future pandemics.

Effect of segmental versus marginal mandibular resection on local and lymph node recurrences in oral squamous cell carcinoma: is tumorous bone infiltration or location and resulting soft tissue recurrences a long-term problem?

PURPOSE: Oral squamous cell carcinomas (OSCCs) adjacent to the mandible or with clinically suspected bone infiltration are surgically treated either with marginal or segmental resections. This retrospective study compared both resections regarding local recurrence and lymph node recurrence or secondary lymph node metastases. METHODS: All consecutive primary OSCC cases between January 2007 and December 2015 that underwent mandibular marginal or segmental resection were included. Rates of local and lymph node recurrences or secondary metastases and possible risk factors such as tumor localization according to Urken's classification were recorded. RESULTS: In total, 180 patients with 85 marginal (group I) and 95 segmental (group II) mandibular resections were analyzed. The local recurrence rates were comparable between the groups (28.2% vs. 27.4%; p = 0.897). Lymph node recurrences or secondary metastases were higher in group I (9.4% (n = 8) vs. 6.2% (n = 6); p = 0.001). Tumor localization appears to affect the outcomes. Significantly fewer local and lymph node recurrences/metastases were found for Urken's classification SB and S calculated by two-proportion z-test (p = 0.014 and 0.056, respectively). Local recurrences mostly emerged from soft tissues, which should be resected more radically than the bones. CONCLUSION: While bone infiltration appears technically well controllable from an oncologic point of view, local recurrences and lymph node recurrences/metastases remain an issue. Regular clinical aftercare with imaging is crucial to detect recurrences.

E-scooter-related craniomaxillofacial injuries compared with bicycle-related injuries - A retrospective study.

The aim of the study was to compare incidences and types of injury incurred between e-scooter crashes and bicycle crashes. This retrospective study included all victims of e-scooter crashes who were treated in the department of oral and maxillofacial surgery during a 12-months interval.A comparison was made with a cohort of patients who underwent bicycle crashes. Study parameters included type of fracture, soft tissue and dental affection, necessity of inpatient or outpatient treatment, the use of helmets, and the time of admission. In total, 400 patients were included. Of these 40 had suffered a crash on an e-scooter and 360 on a bicycle. Descriptive statistics showed a low helmet-wearing rate among cyclists (16.1% of recorded cases), with no helmet wearing recorded among e-scooter users. E-scooter-related crashes showed a higher rate of facial soft-tissue injuries (77.5%, p = 0.049) than among cyclists (61.7%), as well as a higher rate of dental injuries (27.5%, p = 0.017) compared with the bicycle cohort (13.3%). Facial fractures were also more common in the e-scooter cohort (45% vs 25.8%, p = 0.010). Admission was typically at the weekend - in the afternoon for the bicycle cohort and in the evening and at night for the e-scooter cohort. As a consequence of the fact that e-scooter riders seem to have an increased risk of facial injuries, it seems that an awareness campaign might be necessary to encourage helmet usage and to persuade intoxicated persons to use public transportation instead.

Temporal Tendinitis in Craniomandibular Dysfunction (CMD) - Does it Really Exist? A Temporomandibular MRI Investigation.

OBJECTIVES: The aim of the study was to analyze the role of temporal muscle and particularly tendon pathology in patients suffering from craniomandibular dysfunction (CMD) using magnetic resonance imaging. MATERIALS AND METHODS: Retrospective analysis of MRI examinations was carried out with regard to temporal muscle fibrosis and fatty degeneration and particularly temporal tendon rupture, thickening, and degenerative signal alterations. Descriptive statistics and the Mann-Whitney U-test were used for statistical evaluation. RESULTS: Structural lesions of temporal muscle parenchyma were the absolute exception. PD hyperintensity, pronounced contrast enhancement, or peritendinous fluid collections along the temporal tendon were found only to a small extent, and a (partial) rupture occurred in only one case. The tendon diameter showed only slight variability. The Mann-Whitney U-test provided no results indicating a causal connection between degenerative joint or disc disease and temporal tendon pathology. CONCLUSION: A large sample of 128 magnetic resonance imaging examinations provided no evidence of a major role of temporal tendinitis in clinical CMD syndrome. KEY POINTS: · Retrospective analysis of temporal tendon in CMD patients.. · Abnormal structural findings along the tendon seen only rarely.. · Obviously no crucial role of temporal tendon lesions in CMD syndrome.. CITATION FORMAT: · Stimmer H, Grill F, Waschulzik B et al. Temporal Tendinitis in Craniomandibular Dysfunction (CMD) - Does it Really Exist? A Temporomandibular MRI Investigation. Fortschr Röntgenstr 2022; 194: 1242 - 1249.

Does molar distalization by the Beneslider have skeletal and dental impacts? A prospective 3D analysis.

OBJECTIVE: The study aimed to clarify (1) the effect of the Beneslider distalization appliance on maxillary molars (M1+2), (2) the type of tooth movement, and (3) changes in skeletal parameters. STUDY DESIGN: Dental distalization paths and transversal changes were measured according to the distance of the pterygoid vertical as well as on the virtualized 3D plaster model. RESULTS: Distalization of the second premolar (P2; T1 - T2) was 2.51 mm (±1.81 mm; P < .001) combined with a distal tipping of 6.50° (±5.09°; P < .001), whereas for M1 a distalization of 3.49 mm (±1.10 mm) occurred with negligible tipping (0.73° ± 5.04°). No significant differences (T1 - T2) on sagittal and vertical skeletal variables were found within or between G1+2. In contrast, a significant increase in N-Sp' in G2 and in Sp'-Gn in G1+2 with consecutive Hasund index reduction was shown. Comparing T1 and T2, the device had an effect on the transversal development. CONCLUSION: The Beneslider distalization appliance causes an effective distalization of M1+2, with slight second premolar tipping. No modification of skeletal parameters was recorded, but a relevant effect on Hasund index and the transverse was found.

Evaluation of Acute Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 Plasma Levels in Traumatic Brain Injury Patients with and without Intracranial Lesions.

This pilot study aimed to evaluate the association of plasma ubiquitin C-terminal hydrolase-L1 (UCH-L1), glial fibrillary acidic protein (GFAP), and S100 calcium-binding protein B (S100B) with intracranial abnormalities visible on a computed tomography (CT) scan (CT positive) and injury severity in acute traumatic brain injury (TBI). For these purposes, a cohort of 109 adult TBI patients was recruited within 6 h from the injury event. A hyperacute subcohort of 20 patients who had their blood collected within 2 h from injury was analyzed separately for early acute biomarker levels. Levels of GFAP and UCH-L1 were analyzed using the prototype Abbott i-STAT™ TBI Plasma Test (Abbott Laboratories, Abbot Park, IL), alongside S100B measurement (Elecsys; Roche Diagnostics, Penzberg, Germany). In the hyperacute subcohort, GFAP and UCH-L1, but not S100B, levels were significantly higher in the CT-positive group compared to CT-negative patients. AUC values for differentiation between CT-positive and CT-negative patients were 0.97 for GFAP, 0.87 for UCH-L1, and 0.60 for S100B. Severity discrimination, defined by Glasgow Coma Scale (GCS) score, was then analyzed in the total patient cohort. Levels of all three biomarkers were significantly different between mild (GCS, 13-15) and moderate/severe (GCS, 3-12) injury groups. UCH-L1 showed the highest area under the curve value for severity discrimination (0.94), followed by GFAP (0.91) and S100B (0.83). These results support the clinical utility of GFAP and UCH-L1 as TBI biomarkers able to rule out CT-positive injury in acute TBI. Moreover, excellent differentiation of GFAP and UCH-L1 between mild and moderate/severe TBI groups affirms their close association with the underlying pathology.

Prognostic factors for long-term results after condylar head fractures: A comparative study of non-surgical treatment versus open reduction and osteosynthesis.

This longitudinal study compared functional, anatomical, and quality of life (QoL) outcomes after closed reduction (CR) versus open reduction and internal fixation (ORIF) of condylar head fractures (CHFs). The aim was to determine predictability of results and to establish prognostic factors for poor outcomes, thus allowing therapeutic decision making between CR and ORIF. All fractures of the non-surgical group were treated by CR with maxillomandibular fixation (CR-MMF) according to an managed analogically. Morphological and functional results were acquired using axiography and clinical functional diagnostics, as well as MRI in problematic cases. Outcomes were compared with those of a collective of patients treated by ORIF with small fragment screws (SFS), according to a uniform standard. A total of 26 patients with 29 unilateral and bilateral CHFs of the non-surgical group were examined over a period of 28.5 months after completion of therapy and compared with a collective of 54 patients with 73 CHFs treated by ORIF. Statistically significant differences were found between both groups in protrusion and mediotrusion on the fracture side, in favour of ORIF. Significantly more patients in the ORIF group were symptom free in terms of the Helkimo dysfunction index and the RDC TMD compared with conservatively treated patients. Associations between Angle class and Helkimo dysfunction index, and between occlusion or number of teeth and pain after CT, could be confirmed. Given their respective indications, both treatment options demonstrated acceptable results in the majority of cases. However, for therapeutic decision making, it is crucial that the long-term results after CR are significantly less predictable. Our study showed only few positive prognostic factors for a stable functional outcome after CR such as isolated CHFs with stable occlusal conditions in younger patients (<25 years).

Defining secure surgical bone margins in head and neck squamous cell carcinomas: The diagnostic impact of intraoperative cytological assessment of bone resection margins compared with preoperative imaging.

BACKGROUND: Imaging provides crucial staging information for treatment planning of head and neck squamous cell carcinomas (HNSCCs). Despite technical progress in imaging techniques, defining the extent of bone involvement preoperatively remains challenging and requires intraoperative information to control for adequate resection. The intraoperative cytological assessment of the bone resection margins (ICAB) provides information whether bone is infiltrated by carcinoma. The aim of this study was to assess the diagnostic value of preoperative imaging compared with ICAB in order to achieve carcinoma-free bone margins. MATERIALS AND METHODS: 108 HNSCC patients underwent preoperative computed tomography (CT), magnetic resonance imaging (MRI) and orthopantomogram (OPG) for staging and surgical planning. Curative resection was planned based on imaging. Intraoperatively, the resection margins were controlled by ICAB. The diagnostic value of preoperative imaging and ICAB was assessed with reference to the histological findings. RESULTS: CT showed a sensitivity of 89.7%, specificity of 63.0%, positive predictive value (PPV) of 85.9%, and negative predictive value (NPV) of 70.8%. MRI revealed a sensitivity of 45.5%, specificity of 66.7%, PPV of 71.4% and NPV of 40.0%. OPG-imaging had a sensitivity of 64.7%, specificity of 76.2%, PPV of 81.5%, NPV 57.1%. In comparison, ICAB provided a sensitivity of 78.6%, specificity of 95.7%, PPV 73.3%, and NPV 96.7%. The accuracy was 82.1%, 52.9%, 69.0%, and 93.5% for CT, MRI, OPG, and ICAB, respectively. CONCLUSION: Preoperative imaging lacks accuracy in defining adequate bone resection margins, compared with ICAB. ICAB supports preoperative imaging and intraoperative frozen sections to improve bone margin control.

3 T - MRI improves intrameatal cranial nerve detection in CI-candidates.

BACKGROUND: Cochlear implantation meanwhile is a well established standard therapy in different forms of hearing loss in most ages. Clear depiction of the cochleovestibular anatomy and the cochlear nerve are very important for indication and effectiveness of cochlear implantation. Aim/objectives: Therefore the question raises whether Highfield MRI improves precision of preoperative diagnostic imaging especially along the the intrameatal portion of the vestibulocochlear nerve. METHODS: We analyzed the MRI scans of 216 temporal bones from 2007 until 2017. In all patients, CI was planned. We compared examinations using 1.5 and 3.0 T MR systems under the aspect of intracanalicular detection of the facial nerve, cochlear nerve, and the vestibular branches. RESULTS: 3 T-MRI was able to detect the cochlear nerve in all cases, a very important criterion for CI-indication. 3 T-MRI was also superior in the detection of facial nerve and especially the vestibular branches. CONCLUSION AND SIGNIFICANCE: The most effective preoperative examination of CI-candidates is the combination of 3 T MRI and multislice HR-CT of the temporal bone.

What Role Does Synovitis Play in Craniomandibular Dysfunction (CMD)? A 3T-MRI Study. / Welche Rolle spielt die Synovialitis bei der kraniomandibulären Dysfunktion (CMD)? Eine 3T-MRT-Studie.

PURPOSE: The purpose of the present study was to investigate the degree and clinical relevance of synovitis in craniomandibular dysfunction. MATERIALS AND METHODS: In total, 140 temporomandibular joints were examined using a 3 T MRI scanner. Quantitative analysis of synovial enhancement was performed and interrelated with arthrosis deformans, degenerative disc disease, joint effusion, bone marrow edema and restriction of motion. RESULTS: We found a statistically high and significant correlation between the degenerative changes as mentioned above and the intensity of synovial enhancement. CONCLUSION: The study shows that typical MRI findings in CMD patients are often combined with signs of synovitis. Presumably joint inflammation has an effect on the clinical signs and symptoms and also the prognosis of CMD. These results should be taken into consideration when selecting treatment. KEY POINTS: · 3T-MRI using a dedicated coil is the method of first choice in the examination of CMD syndrome.. · MR imaging allows quantification of increased synovial enhancement.. · There is a highly significant correlation between degenerative changes of the disc or cartilage and synovitis.. · Results of the study are relevant for the clinical assessment and therapy of CMD syndrome.. CITATION FORMAT: · Stimmer H, Ritschl L, Goetz C et al. What Role Does Synovitis Play in Craniomandibular Dysfunction (CMD)? A 3T-MRI Study. Fortschr Röntgenstr 2019; 191: 924 - 931.

Biomechanical loading test on reconstructed mandibles with fibular, iliac crest or scapula graft: a comparative study.

Advantages and disadavantages of the three most commonly-used bone grafts for mandibular reconstruction are widely known, but biomechanical experimental studies are rare. We have done loading tests on cadaveric mandibles reconstructed with fibular, iliac crest, and scapular grafts using 3 different osteosynthesis systems to detect and compare their primary stability. Loading tests were done on mandibles with grafts from the fibula and iliac crest and published previously. A 4.5cm paramedian L-type defect was reconstructed with scapula using 2 monocortical non-locking plates, 2 monocortical locking plates, or a single bicortical locking plate/fracture gap in 18 human cadaveric mandibles. These were loaded on to the "Mandibulator" test bench and the movement of fragments in 3 dimensions was assessed and quantified by a PONTOS® optical measurement system. Comparison of the osteosynthesis groups showed that the miniplate was significantly superior to the 6-hole TriLock® plate for both fibular and iliac crest grafts. The fibular graft gave greater stability than the iliac crest and scapular grafts for all 3 osteosynthesis systems. All bony specimens offered sufficient resistance to mechanical stress within the recognised range of biting forces after mandibular reconstruction, independently of the choice of bone graft and osteosynthesis system used. Anatomical and surgical advantages need to be taken into account when choosing a graft. Stability can be maximised with a fibular graft, and further optimised by enlarging the binding area by using the "double barrel" method. Computer simulated experiments could segregate factors that biased results, such as morphological differences among cadavers.

High-grade supraclavicular soft tissue sarcoma as secondary malignancy after successful treatment of acute myeloid leukemia: case report and literature review.

It is well known that the treatment protocols for hematopoetic neoplasms carry a high risk of long-term oncogenicity. However, few reports have been published of sarcomas as secondary malignancies. An unusual case report of a soft tissue sarcoma appearing as a secondary cancer is presented, with a review of the published data. The present report involves a soft tissue sarcoma of the neck that occurred 18 years after curative treatment of acute myeloid leukemia by induction chemotherapy and bone marrow transplantation. Consecutive graft-versus-host disease affected the cervical skin. Soft tissue sarcomas appearing as secondary tumors are rare in oncology. The presented case describes the appearance of a sarcoma 18 years after curative treatment of acute myeloid leukemia. This is only the second case of this type reported in published studies.

Peroneal perforator flap for intraoral reconstruction.

Thin and pliable flaps with long, high calibre pedicles are ideally suited to lining the inside of the mouth. The radial forearm free flap has been our flap of choice until now, but we are unhappy with its potential for complications at the donor site. As an alternative, 30 patients have been treated in our unit with peroneal perforator flaps. Magnetic resonance (MR) angiography is necessary preoperatively to identify major perforating vessels. Flaps were raised using a lateral approach after the position of the most suitable perforator had been marked on the skin. The skin flaps were outlined in the proximal half of the lower leg with a maximum width of 5 cm to allow for direct closure of the wound. Five patients (of the original 35) were excluded after the results of MR angiography were known. All perforators identified on MR angiography could be exposed in the proximal half of the lower leg and most had a septocutaneous course. Reconstructions were in the floor of the mouth (n=16), tongue (n=11), and buccal mucosa (n=3). All but one flap survived with satisfactory functional results. The donor site morbidity was low. With the aid of MR angiography the peroneal perforator flap is a safe option for intraoral reconstruction. For small and medium sized defects we think that this flap is a good alternative to others, particularly if direct closure at an inconspicuous donor site is desired.

Enlargement of the cochlear aqueduct: does it exist?

Our intention was to evaluate whether enlargement of the cochlear aqueduct could play a role in dysfunctions of the inner ear. There is little literature dealing with the question of cochlear aqueduct (CA) enlargement and results of reported radiological examinations are contradictory. Therefore, we decided to analyse 400 high-resolution CT-scans of the temporal bone to examine the diameter of the CA. We used scan-data from a 64-line multislice spiral-CT-scanner stored in our PACS-System. CA-enlargement was defined as a diameter of more than 1 mm in the whole otic capsule portion. A classification with four types of CA's proposed by Migirov and Kronenberg in 2005 was applied. Statistical analysis of diameters, different CA-types and side asymmetry was performed. We did not find any CA exceeding 1 mm in diameter in the otic capsule portion, there is no evidence of CA-enlargement, not even in patients with inner ear malformation. A new aspect compared with published literature to date is that nearly in all cases CA was identified, but in different degrees. According to our findings, it seems to be very unlikely that CA-enlargement is a reason for pathologic inner ear condition as it is in case of large vestibular aqueduct.

Evaluation of the vessels of the lower leg before microsurgical fibular transfer. Part II: magnetic resonance angiography for standard preoperative assessment.

The peroneal artery is the dominant supply of the osteomyocutaneous fibular flap. It has been shown that there can be anatomical variants that could jeopardise the blood supply to the lower limb during harvest of the flap. To avoid postoperative ischaemia of the lower leg, preoperative evaluation of adequate collateral perfusion is essential. We investigated whether magnetic resonance angiography (MRA) accurately shows anatomical variants and pathological stenoses of the vessels of the lower leg and whether it can replace conventional invasive techniques. Conventional digital subtraction angiography (DSA) was used in a prospective study of 15 patients, and contrast-enhanced MRA postoperatively. Arteries were evaluated by three radiologists for: size of vessel at the trifurcation; hypoplastic or missing vessels; appreciable stenosis or vascular occlusion, or both; atherosclerotic malformations; and overall vascular topography. High resolution MRA enabled a reliable judgement to be made of the vessels of the lower leg. MRA definitively detected hypoplastic vessels, stenoses, occlusion, or atherosclerotic changes of the vessels, and enabled both accurate assessment of the quality of vessels and the preferred site for the harvest of the flap. As it is a low risk procedure, it can be done in the outpatient department with no risk of radiation. It can easily replace conventional DSA.