[A PhD completed. Pre-surgical assessment of the mandibular body and canal using CBCT imaging.] / Serie: Hora est. Prechirurgisch onderzoek van mandibula en canalis mandibularis met CBCT-scans.

The aim of this study was to determine the accuracy of the pre-surgical assessment of the mandible using cone beam computed tomography (CBCT) images. For surgical procedures in the mandible, it is important to determine the position of the mandibular canal in order to avoid damage to the inferior alveolar nerve (IAN). The best method to investigate this nerve is with the help of panoramic reconstructed images combined with cross-sectional reconstructed images. To protect the IAN during treatment, this research indicates that a minimal safety zone of 1.13 mm is advisable. When distances were being measured, a larger exaggeration of reality was observed with small distances. It appears that (semi)automatic tracing methods of the mandibular canal still cannot be used in clinical practice. When a CBCT scan reveals a lingual position of the mandibular canal in combination with a narrowing of the mandibular canal at the contact point with the root of a third molar the risk of damaging the IAN increases. CBCT imaging should only be applied in specific cases.

Clinical relevance of cone beam computed tomography in mandibular third molar removal: A multicentre, randomised, controlled trial.

PURPOSE: The aims of this study were to investigate the effectiveness of cone beam computed tomography (CBCT) compared to panoramic radiography (PR), prior to mandibular third molar removal, in reducing patient morbidity, and to identify risk factors associated with inferior alveolar nerve (IAN) injury. MATERIAL AND METHODS: This multicentre, randomised, controlled trial was performed at three centres in the Netherlands. Adults with an increased risk for IAN injury, as diagnosed from PR, were included in the study. In one arm of the study, patients underwent an additional CBCT prior to third molar surgery. In a second arm of the study, no additional radiographs were acquired. The primary outcome measure was the number of patient-reported altered sensations 1 week after surgery. As secondary outcome measures, the number of patients with objective IAN injury, with long-term (>6 months) IAN injury, the occurrence of other postoperative complications, the Oral Health Related Quality of Life-14 (OHIP-14) questionnaire responses, postoperative pain (visual analogue scale score), duration of surgery, number of emergency visits, and number of missed days of work or study were scored. RESULTS: A total of 268 patients with 320 mandibular third molars were analysed according to the intention-to-treat principle. The overall incidence of IAN injury 1 week after surgery was 6.3%. No significant differences between CBCT and PR for temporary IAN injury (p = 0.64) and all other secondary outcomes were registered. A lingual position of the mandibular canal (MC) and narrowing, in which the diameter of the MC lumen was decreased at the contact area between the MC and the roots, were significant risk factors for temporary IAN injury. CONCLUSION: Although CBCT is a valuable diagnostic adjunct for identification of an increased risk for IAN injury, the use of CBCT does not translate into a reduction of IAN injury and other postoperative complications, after removal of the complete mandibular third molar. In these selected cases of a high risk for IAN injury, an alternative strategy, such as monitoring or a coronectomy, might be more appropriate. (http://clinicaltrials.gov, NCT02071030).

The clinical relevance of bifid and trifid mandibular canals.

BACKGROUND: Bifid mandibular canals (BMC) and trifid mandibular canals (TMC) are variations on the normal anatomy with incidences ranging from 0.08% to 65.0%. Such aberrations have an important clinical impact. For example, an extra mandibular canal may explain inadequate anesthesia, especially when two mandibular foramina are involved. Furthermore, during mandibular surgery, a second, or even third, neurovascular bundle may be damaged causing paresthesia, neuroma development, or bleeding. CASE REPORT: Two cases are presented in this article. One patient had a BMC on both sites, and the other patient had a TMC on one site and a BMC on the other site. DISCUSSION: Initial screening for the presence of a BMC or TMC can be executed by conventional panoramic radiography. BMCs or TMCs are diagnosed, before executing mandibular surgery; additional CBCT scanning is indicated.

[Bifid and trifid mandibular canal. A coincidental finding]. / Canalis mandibulae bifidus en trifidus. Een toevalsbevinding.

A 26-year-old man was suffering from pericoronitis of his mandibular third molars. To determine the position of the mandibular canal in relation to the roots of the third molars, a panoramic radiograph was made. The radiograph revealed at the right side a bifid mandibular canal and the upper part of the canal seemed to be related to the third molar. Additionally, a cone beam CT was made, which revealed a bifid mandibular canal at the left side and a trifid mandibular canal at the right side. Anatomical anomalies of the mandibular canal may have clinical implications, such as an increased risk of injury to the inferior alveolar nerve in case of removing a mandibular third molar and inadequate local anesthetics.

The effect of hyperbaric oxygen therapy on quality of life in oral and oropharyngeal cancer patients treated with radiotherapy.

Radiotherapy is used in the setting of curative treatment for head and neck cancer. Xerostomia and related problems occur when major salivary glands are included in the irradiation fields. This reduces quality of life (QOL). Hyperbaric oxygen therapy (HBOT) is a well accepted treatment or prevention modality for osteoradionecrosis of the jawbones and soft-tissue necrosis. It is unknown if and to what extent HBOT influences xerostomia and xerostomia-related QOL. To address this, a prospective study was conducted. Twenty-one patients who underwent radiotherapy for an oral or oropharyngeal carcinoma completed a European Organization for Research and Treatment of Cancer QOL questionnaire before HBOT, as part of the treatment/prevention of osteoradionecrosis, and 1 and 2 years after HBOT. Swallowing-related problems significantly decreased in time, and there was a reported subjective increase in saliva quantity and an improvement in sense of taste. The results suggest that HBOT may positively influence these long-term radiotherapy sequelae.

[Involuntary patient admission and treatment against patient's will by emergency physicians]. / Zwangseinweisung und Zwangsbehandlung bei psychiatrischen Patienten als notärztliche Aufgabe.

INTRODUCTION: The treatment of acutely ill patients who presumably lack the insight or judgement to determine their need for medical treatment, is a difficult challenge for emergency physicians. We have carried out a study to assess the frequency and relevance of involuntary treatment and procedures in medical emergency services. METHODS: Retrospective chart analysis for a 1-year period was performed for all treatment protocols of a medical emergency service unit and for all court-ordered treatments of a guardianship court. Cases of involuntary treatment by emergency physicians were identified and analysed. RESULTS: In 10.4% of all emergency calls analysed a relevant and acute psychiatric condition was found. In 0.3% of the cases or 4.8% of the psychiatric cases, involuntary inpatient commitment was chosen by the emergency physician. DISCUSSION: Involuntary inpatient commitment by emergency physicians was only necessary in relatively few cases. Nevertheless, in order to be able to correctly consider treatment and management options, emergency physicians should be aware of the basic conditions for treatment without a patient's consent.

The Drosophila homolog of the human AF10 is an HP1-interacting suppressor of position effect variegation.

In chromosomal rearrangements of acute myeloid leukaemia patients the mixed lineage leukaemia (MLL) gene, a human homolog of the Drosophila gene trithorax, is frequently fused to AF10. Here we describe the identification and a functional characterization of the Drosophila homolog dAF10. We show that dAF10 functions in heterochromatin-dependent genomic silencing of position effect variegation, a phenomenon associated with chromosomal rearrangements that cause mosaic expression of euchromatic genes when relocated next to heterochromatin. We also demonstrate that dAF10 can associate with the heterochromatin protein 1 (HP1) in vitro and in vivo. The results indicate that dAF10 is an HP1-interacting component of the heterochromatin-dependent gene silencing pathway, which either contributes to the stability of the heterochromatin complex or to its function.