Learning and implementation of TransREctus sheath PrePeritoneal procedure for inguinal hernia repair.

PURPOSE: The TransREctus sheath PrePeritoneal procedure (TREPP) was introduced as an alternative open and preperitoneal technique for inguinal hernia mesh repair, demonstrating safety and efficacy in retro- and prospective studies. However, little is known about the technique's inherent learning curve. In this study, we aimed to determine TREPP learning curve effects after its implementation in high-volume surgical practice. METHODS: All primary, unilateral TREPP procedures performed in the first three years after implementation (between January 2016 and December 2018) were included out of a large preconstructed regional inguinal hernia database. Data were analyzed on outcome (i.e., surgical complications, hernia recurrences, postoperative pain). Learning curve effects were analyzed by assessing outcome in relation to surgeon experience. RESULTS: In total, 422 primary, unilateral TREPP procedures were performed in 419 patients. In three patients a unilateral TREPP procedure was performed on both sides separated in time. A total of 99 surgical complications were registered in 83 procedures (19.6% of all procedures), most commonly inguinal postoperative pain (8%) and bleeding complications (7%). Hernia recurrences were observed in 17 patients (4%). No statistically significant differences on outcome were found between different surgeon experience (< 40 procedures, 40-80 procedures, > 80 procedures). CONCLUSION: Implementation of TREPP seems not to be associated with a notable increase of adverse events. We were not able to detect a clear learning curve limit, potentially suggesting a relatively short learning curve among already experienced hernia surgeons compared to other guideline techniques.

The influence of food consistency on chewing rate and muscular work.

Food properties influence the parameters of the masticatory process, such as jaw movement, muscle activity and chewing rate. Firm foods will require more muscle activity than softer foods. However, the influence of food hardness on chewing rate is ambiguous as both slower and higher chewing rates have been reported for harder foods. Rheological characteristics of the food, such as plasticity and elasticity, may help to explain differences in chewing rate. The aim of our study was to determine the influence of food properties on chewing rate and muscular work in five phases of a chewing sequence. Eighty-four participants chewed on five foods, which strongly differed in consistency. Chewing gum was used as a reference food. The phase in the chewing sequence had a large significant effect on cycle duration for the five foods. A significant decrease in cycle duration at the beginning of chewing was followed by an increase in later phases, leading to U-shaped curves. Food type had a small effect on the average cycle duration. However, large significant differences in cycle duration were observed between the foods at the beginning of a chewing sequence. In that phase, the firm foods were chewed much slower than the soft foods. Muscular work was significantly influenced by both chewing phase and food type.

The influence of oral processing, food perception and social aspects on food consumption: a review.

Eating is an essential activity to get energy and necessary nutrients for living. While chewing, the food is broken down by the teeth and dissolved by saliva. Taste, flavour and texture are perceived during chewing and will contribute to the appreciation of the food. The senses of taste and smell play an important role in selecting nutritive food instead of toxic substances. Also visual information of a food product is essential in the choice and the acceptance of food products, whereas auditory information obtained during the chewing of crispy products will provide information on whether a product is fresh or stale. Food perception does not just depend on one individual sense, but appears to be the result from multisensory integration of unimodal signals. Large differences in oral physiology parameters exist among individuals, which may lead to differences in food perception. Knowledge of the interplay between mastication and sensory experience for groups of individuals is important for the food industry to control quality and acceptability of their products. Environment factors during eating, like TV watching or electronic media use, may also play a role in food perception and the amount of food ingested. Distraction during eating a meal may lead to disregard about satiety and fullness feelings and thus to an increased risk of obesity. Genetic and social/cultural aspects seem to play an important role in taste sensitivity and food preference. Males generally show larger bite size, larger chewing power and a faster chewing rhythm than females. The size of swallowed particles seems to be larger for obese individuals, although there is no evidence until now of an 'obese chewing style'. Elderly people tend to have fewer teeth and consequently a less good masticatory performance, which may lead to lower intakes of raw food and dietary fibre. The influence of impaired mastication on food selection is still controversial, but it is likely that it may at least cause adaptation in food choice. Systemic conditions, such as high blood pressure, diabetes and cancer, with or without medicine use, tend to be associated with taste and chewing alterations. However, definite conclusions seem hard to reach, as research protocols vary largely.

Assessment of the oral health condition of nursing home residents by primary care nurses.

We interviewed 36 primary care nurses in three Dutch nursing homes regarding the functional oral health and dental treatment needs of 331 care-dependent residents (average age 77.8 years). The nurses assessed the residents' oral health condition as good (8.3 on a scale of 0 to 10). Edentulous residents wearing dentures were considered to have better functional oral health than dentate residents wearing partial dentures and edentulous residents not wearing dentures. According to the nurses, only 9% of the residents required dental treatment. This finding is in contrast with an intraoral study of the same population, in which dentists determined that 73% of the residents needed dental treatment.

Integrated versus incidental dental care in nursing homes.

PURPOSE/AIM: In most of the 334 Dutch nursing homes, incidental dental care is provided upon indication by the medical and nursing staff. However, more and more nursing homes offer integrated dental care, where a dentist works on a structural basis in facilities within the home. METHODS: To evaluate the costs and effects of integrated versus incidental care, we studied the oral status and treatment needs in two nursing homes in the same city with 175 and 120 residents an average age of 81.7 and 79.3 years, respectively. RESULTS: In the integrated care home, the dentist spent an average 2.2 hours/year per resident at a cost of €229 for the dentist's work and €143 for laboratory costs. In the incidental care home, these values were 0.1 hours/year per resident at a cost of €15 for the dentist's work and €20 for laboratory costs. CONCLUSIONS: With integrated care, 55.6% of the residents had no oral treatment need versus 13.1% for incidental care, more edentulous residents wore dentures, and residents had less soft tissue pathology.

From brain to bridge: masticatory function and dental implants.

Masticatory function is an important aspect of oral health, and oral rehabilitation should aim to maintain or restore adequate function. The present qualitative review is the joint effort of a group of clinicians and researchers with experiences ranging from basic and clinical oral neuroscience to management of patients with dental implants. The aim is to provide a short summary for the clinician of the many aspects related to masticatory function (including quality of life) and rehabilitation with dental implants. While there are many reviews on the tissue responses to dental implants and technical aspects, the functional aspects have received relatively little focus.

[Dissertations 25 years after date 32. Physiological aspects of mastication]. / Proefschriften 25 jaar na dato 32. Fysiologische aspecten van het kauwproces.

Mastication is the first phase of the digestive process. It serves to reduce the size ofsolid food and to mix it with saliva so that it can be swallowed. The degree to which food is reduced in size depends on various factors, such as the masticatory force generated by the jaw muscles, the number and form of the (pre-)molars, the neuro-muscular control of the movements of the mandible and the quantity and composition of the saliva. If the mastication is to operate efficiently, form and function have to be properly balanced. Disturbances in function and abnormalities inform can lead to complaints and are often accompanied by a diminished fragmentation of the food. By investigating the fundamental mechanisms of the functional process, abnormalities can clinically be better understood.

The influence of a Le Fort I impaction and advancement osteotomy on smile using a modified alar cinch suture and V-Y closure: a prospective study.

A previous report from the authors' department showed that a modified alar cinch suture combined with a muco-musculo-periosteal V-Y closure (mACVY) improves nasolabial mobility. To test if the improvements were equal to the range of nasolabial mobility in non-dysgnathic persons, a prospective study was carried out in 56 patients: 31 with mACVY, 25 with simple closing sutures (SCS) and 18 non-operated, angle class I volunteers. Standardized full facial frontal photographs, taken immediately preoperatively and 18 months postoperatively were used. The landmarks, alare, crista philtri and cheilion were analysed. The test has a standard deviation of 0.9 mm. Intra-group changes, paired t-test, and inter-group differences, unpaired t-test (p<0.05) were statistically analysed. The results show significant preoperative differences in nasolabial mobility compared with the control group, for both groups. Postoperative mobility improved in both groups, but significantly with mACVY with horizontal movement of cheilion and alare, and the vertical movement of crista philtri and less so for the vertical movement of crista philtri with SCS. Postoperative inter-group differences in mobility were small and significant for SCS vs the control group. It can be concluded that using mACVY improves orofacial movement to the level of normal class I volunteers.

Digital image processing versus visual assessment of chewed two-colour wax in mixing ability tests.

Two-colour chewing gum and wax have been widely used as test foods to evaluate the ability to mix and knead a food bolus. The mixing of the colours has been assessed by computer analysis or by visual inspection. Reports contradict each other about whether computer analysis and visual assessment could equally well discriminate between the masticatory performances of groups of participants with different dental status. This study compares the results of computer analysis of digital images of chewed two-colour wax with the results of visual assessment of these images. Sixty healthy subjects participated and chewed on red-blue wax for 5, 10, 15 and 20 chewing strokes. The subjects were divided into three groups of 20, matched for age and gender, according to their dental status: natural dentition, full dentures and maxillary denture plus implant-supported mandibular overdenture. Mixing of the chewed wax was determined by computer analysis of images of the wax and by visual assessment of the images by five examiners. Both the computer method and the observers were able to distinguish the mixing abilities of the dentate subjects from the two denture wearer groups. Computer analysis could also discriminate the mixing abilities of the two denture groups. However, observers were not able to distinguish the mixing abilities of the two denture groups after 5, 10 and 15 chewing strokes. Only after 20 chewing strokes, they could detect a significant difference in mixing ability.

Tongue function in patients treated for malignancies in tongue and/or floor of mouth; a one year prospective study.

Progress in (reconstructive) surgery and radiotherapy tends to improve survival and reduce oral functional deficits. Despite the growing sophistication of cancer treatment, patients still report deterioration in tongue function. Sensory function, mobility, and force of the tongue were determined in 45 patients with a carcinoma of tongue and/or floor of mouth. Measurements were performed before surgery, shortly after surgery, shortly after radiotherapy, 6, and 12 months after surgery. Surgery had a negative impact on tongue sensory function and mobility. Post-surgery radiotherapy did not further deteriorate sensory function, mobility, or force of the tongue. Patients in the surgery-radiotherapy group (SRG) had significantly worse tongue sensory function and mobility than patients in the surgery group (SG), probably caused by more advanced tumour stage and more extensive reconstructions and related scar tissue. The tongue force in patients in both groups significantly increased in the first 6 months after surgery, but this increase disappeared in the next 6 months. The authors conclude that surgery had a significant negative influence on tongue function, especially in the group of patients treated with radiotherapy. No further deterioration of tongue function was observed after post-surgical radiotherapy within the first year after surgery.

Drug-induced caspase 8 upregulation sensitises cisplatin-resistant ovarian carcinoma cells to rhTRAIL-induced apoptosis.

BACKGROUND: Drug resistance is a major problem in ovarian cancer. Triggering apoptosis using death ligands such as tumour necrosis factor-related apoptosis inducing ligand (TRAIL) might overcome chemoresistance. METHODS: We investigated whether acquired cisplatin resistance affects sensitivity to recombinant human (rh) TRAIL alone or in combination with cisplatin in an ovarian cancer cell line model consisting of A2780 and its cisplatin-resistant subline CP70. RESULTS: Combining cisplatin and rhTRAIL strongly enhanced apoptosis in both cell lines. CP70 expressed less caspase 8 protein, whereas mRNA levels were similar compared with A2780. Pre-exposure of particularly CP70 to cisplatin resulted in strongly elevated caspase 8 protein and mRNA levels. Caspase 8 mRNA turnover and protein stability in the presence or absence of cisplatin did not differ between both cell lines. Cisplatin-induced caspase 8 protein levels were essential for the rhTRAIL-sensitising effect as demonstrated using caspase 8 small-interfering RNA (siRNA) and caspase-8 overexpressing constructs. Cellular FLICE-inhibitory protein (c-FLIP) and p53 siRNA experiments showed that neither an altered caspase 8/c-FLIP ratio nor a p53-dependent increase in DR5 membrane expression following cisplatin were involved in rhTRAIL sensitisation. CONCLUSION: Cisplatin enhances rhTRAIL-induced apoptosis in cisplatin-resistant ovarian cancer cells, and induction of caspase 8 protein expression is the key factor of rhTRAIL sensitisation.

Effect on the contour of bone and soft tissue one year after harvesting chin bone for alveolar cleft repair.

In this study the authors evaluate and quantify the residual bony defect in the mandibular symphysis and its effect on the soft tissue contour a minimum of 1 year after harvesting chin bone. 59 ASA I cleft lip and palate patients, aged 8-19 years were included. In all patients an autologous bone graft from the mandibular symphysis was harvested for transplantation to the alveolar cleft. Lateral cephalograms were used to measure the donor site defects, and the effects on the soft tissue contour. An evident residual defect was measured at the donor site 1 year after harvesting chin bone. A significant relation was seen between age at time of surgery and size of the defect 1 year postoperatively. In older patients a larger defect remained. Using the current surgical technique of harvesting chin bone, complete bony repair of the defect was not achieved. This study shows postoperatively persisting defects that comprise on average 14% of the original peroperative defects. A significant increase in soft tissue thickness was seen at the mandibular symphysis at a minimum of 1 year postoperatively. These changes in the soft tissue chin contour 1 year after harvesting bone are similar to normal growth changes.

Comparing masticatory performance and mixing ability.

Masticatory performance has often been measured by determining an individual's capacity to comminute a test food. Another method to determine masticatory performance, which is now widely used, evaluates the ability to mix and knead a food bolus. Two-coloured chewing gum and paraffin wax have been used as test foods for the quantification of the mixing ability. The aim of our study was to compare the results obtained with the comminution of an artificial test food and the results obtained from mixing of a two-coloured chewing gum. The degree of mixing of the colours of the chewing gum was quantified with an optical method. Twenty young subjects with a natural dentition (average age 24 years) and twenty elderly subjects, mostly with complete dentures (average age 72 years), participated in the study. Significant differences in masticatory performance between the two groups were detected with both methods. However, the comminution test was better in discriminating the masticatory performance of the two groups. The mixing ability test with the two-coloured chewing gum proofed to be a good method to determine masticatory function in subjects with a compromised masticatory performance (elderly subjects). However, the method appeared to be less suitable for subjects with a good masticatory performance (young subjects).

Mixing ability test compared with a comminution test in persons with normal and compromised masticatory performance.

A mastication test was needed with a material that forms a bolus and is soft enough to be chewed by persons with compromised oral function, in particular patients confronted with oral cancer. We therefore developed a wax-mixing ability test and compared it with a comminution test using Optocal as test food. We hypothesized that the mixing ability test would be better at differentiating between groups of persons with compromised masticatory performance than the comminution test. Sixty healthy subjects were recruited in three groups of 20, matched for age and gender: a group with natural dentition; a group with full dentures; and a group with maxillary denture and implant-supported mandibular overdenture. The mixing ability test was found to discriminate better between the two full-denture groups than the comminution test.

Revisional surgery following the superiorly based posterior pharyngeal wall flap. Historical perspectives and current considerations.

The aim of this study was to describe the surgical and functional complications following superiorly based posterior pharyngeal wall (SBPP) flap surgery. Records of 130 patients with velopharyngeal insufficiency (VPI) who had undergone SBPP flap surgery as a secondary procedure to reduce nasal resonance in speech were reviewed. Complications were defined as the incidence of revisional surgery required to obtain a more satisfactory result. 20 patients (15%) required revisional surgery. In 4 patients (3%) early revisional surgery was indicated to treat surgical complications (1 postoperative bleeding, 3 flap dehiscences). In 16 patients (12%) late revisional surgery was indicated to achieve a better functional result with regard to nasal resonance in speech. The low incidence of surgical complications indicates that SBPP flap surgery is a safe procedure. After SBPP flap surgery, a satisfactory functional result with respect to nasal resonance was obtained in 88% of patients. This result was improved after revisional surgery. The hypothesis that the patients of an experienced surgeon have fewer complications and better functional results than those of a less experienced one was tested. The individual skill of the surgeon rather than their experience led to a better functional result.

The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies.

UNLABELLED: Adverse effects on the soft tissues after Le Fort I osteotomies include: broadening of the alar base, loss of vermilion show of the upper lip and down sloping of the commissures. In theory, an alar cinch suture combined with a muco-musculo-periosteal V-Y closure (ACVY) should improve not only the nasal width, but would also improve the dynamics of some of the mimic muscles. To test the validity of this hypothesis, a prospective study was set up including 22 patients, using standardized full facial frontal photographs, taken immediately preoperatively and 18 months postoperatively. Sets containing three pictures were made: soft tissue in repose, maximum closed mouth smile and maximum smile. The landmarks, alare, crista philtri and cheilion were analysed. The preliminary results show that ACVY-closure does significantly improve the horizontal movement of cheilion with both maximum closed mouth smile and maximum smile, as well as the vertical movement of crista philtri with maximum closed mouth smile. CONCLUSION: The Le Fort I osteotomy with ACVY improves the orofacial dynamics.

A prospective study on prognostic factors for free-flap reconstructions of head and neck defects.

The purpose of this study is to examine a cohort of patients with free-flap reconstruction prospectively and to identify the prognostic factors for postoperative medical and surgical complications. All 150 patients required a free-flap reconstruction after ablative surgery for a defect in the head and neck area. Medical complications and major surgical complications were correlated with patient factors. An ASA score of 3 and male gender were statistically significant prognostic factors for medical complications. The ASA scoring system is a slightly better prognostic factor for medical complications than Charlson comorbidity stage on forward logistic regression analysis. Female gender and an operation time exceeding 10h were statistically significant prognostic factors for major surgical complications.

Masticatory function in subacute TMD patients before and after treatment.

Masticatory function can be impaired in temporomandibular disorders (TMDs) patients. We investigated whether treatment of subacute non-specific TMD patients may influence oral function and clinical outcome measures. Fifteen patients with subacute TMD participated in the study. We quantified masticatory performance, maximum voluntary bite force, muscle activity and chewing cycle duration before and after treatment. Masticatory performance and bite force of patients were compared with the results obtained for an age- and gender-matched group of subjects without TMD complaints. Furthermore, we determined possible changes in anamnestic and clinical scores from questionnaires (mandibular function impairment questionnaire; MFIQ), pain scores and clinical outcome measures. Maximum bite force significantly increased, although the values after treatment were still significantly lower than those of the subjects without TMD complaints. The corresponding electromyography values did not show significant change after treatment. The masticatory performance of the patients remained unaltered; patients chewed significantly less efficient than controls. The average duration of chewing cycles significantly decreased after treatment. We observed a significant improvement in MFIQ scores. During the clenching and chewing tasks, the visual analogue scale scores were significantly higher than before these tasks. We may conclude that subacute temporomandibular joint disorders negatively influence chewing behaviour. Bite force, chewing cycle duration and also perceived mandibular function significantly improved after treatment, although the masticatory performance remained unaltered.

The reliability of frontal facial photographs to assess changes in nasolabial soft tissues.

A simple, modified method to evaluate changes in the nasolabial soft tissues after orthognathic surgery is presented. Eighteen healthy volunteers were photographed in a standardized manner with a 2-month interval. Pictures were taken with the soft tissues in repose and 'maximum closed mouth smile'. Discrepancies for repose and dynamic excursions (x and y coordinates) were calculated for the landmarks alare, crista philtri and cheilion. Multiple analysis of variance revealed no significant interaction for intra-observer variance and time of recording. Coefficients of reliability (repose: 90-99%, dynamic excursion (cheilion): >95%), Spearman correlation coefficients (repose: >0.8, dynamic: >0.6) and squared correlation (repose: >75%, dynamic: >50%) showed this method to be reliable for repose and dynamic excursions. The error of measurement was less than 1.8 mm for both repose and dynamic excursions (SD(differences)=0.9 mm). This is smaller than mean differences in nasolabial soft-tissues excursions found between the pre- and post-Le Fort I osteotomy situation in a previous study using video imaging. The discrepancies found were in keeping with other earlier reports for 2D and 3D measuring methods. The method as proposed is simple, cost effective and can be used to evaluate soft-tissue changes after orthognathic surgery.

Influence of occlusal vertical dimension on the masticatory performance during chewing with maxillary splints.

Changing the occlusal vertical dimension is a common procedure in restorative dentistry, during treatment of patients with cranio-mandibular disorders, and during orthodontic and orthognathic treatment. The treatment may alter the length of the main jaw elevator muscles and the position of the mandibular head in the fossa temporalis. These changes may influence the bite forces that are generated during chewing and thus may affect the masticatory function. We measured the objective masticatory function, defined as masticatory performance, by determining an individual's capacity to pulverize a test food. The immediate influence of the increase in the occlusal vertical dimension on the masticatory performance was determined using three anatomical maxillary splints in a group of seven dentate subjects. The splints gave an increase in the occlusal vertical dimension of 2, 4 and 6 mm, respectively. Before we started the experiments the subjects practiced chewing with the splints during about 5 min. No significant differences were observed in masticatory performance among the conditions without and with the three splints. Thus, an increase in the occlusal vertical dimension up to 6 mm did not have a significant effect on the masticatory performance. Maxillary splints may be used to study the effect of occlusal factors on the chewing process by manipulating tooth shape and occlusal area of the splint.