Comparison of three-dimensional imaging of the nose using three different 3D-photography systems: an observational study.

BACKGROUND: New 3D technologies for superficial soft tissue changes, especially in plastic and reconstructive surgical procedures, can improve the planning and documentation of facial surgeries. The purpose of this study was to compare and determine the applicability and feasibility of three different 3D-photography systems in clinical practice imaging the nose. METHODS: A total of 16 healthy non-operated noses were included in this prospective study. A plaster model of each nose was produced, digitized, and converted to a .stl mesh (= ground truth model). Three-dimensional images of each nose were then taken using Artec Space Spider (gold standard), Planmeca ProFace®, and the Bellus3D Dental Pro application. All resulting .stl files were aligned to the ground truth model using MeshLab software, and the root mean square error (RMSE), mean surface distance (MSD), and Hausdorff distance (HD) were calculated. RESULTS: The Artec Space Spider 3D-photography system showed significantly better results compared to the two other systems in regard to RMSE, MSD, and HD (each p < 0.001). There was no significant difference between Planmeca ProFace® and Bellus3D Dental Pro in terms of RMSE, MSD, and HD. Overall, all three camera systems showed a clinically acceptable deviation to the reference model (range: -1.23-1.57 mm). CONCLUSIONS: The three evaluated 3D-photography systems were suitable for nose imaging in the clinical routine. While Artec Space Spider showed the highest accuracy, the Bellus3D Dental Pro app may be the most feasible option for everyday clinical use due to its portability, ease of use, and low cost. This study presents three different systems, allowing readers to extrapolate to other systems when planning to introduce 3D photography in the clinical routine.

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.

Face the Future-Artificial Intelligence in Oral and Maxillofacial Surgery.

Artificial intelligence (AI) has emerged as a versatile health-technology tool revolutionizing medical services through the implementation of predictive, preventative, individualized, and participatory approaches. AI encompasses different computational concepts such as machine learning, deep learning techniques, and neural networks. AI also presents a broad platform for improving preoperative planning, intraoperative workflow, and postoperative patient outcomes in the field of oral and maxillofacial surgery (OMFS). The purpose of this review is to present a comprehensive summary of the existing scientific knowledge. The authors thoroughly reviewed English-language PubMed/MEDLINE and Embase papers from their establishment to 1 December 2022. The search terms were (1) "OMFS" OR "oral and maxillofacial" OR "oral and maxillofacial surgery" OR "oral surgery" AND (2) "AI" OR "artificial intelligence". The search format was tailored to each database's syntax. To find pertinent material, each retrieved article and systematic review's reference list was thoroughly examined. According to the literature, AI is already being used in certain areas of OMFS, such as radiographic image quality improvement, diagnosis of cysts and tumors, and localization of cephalometric landmarks. Through additional research, it may be possible to provide practitioners in numerous disciplines with additional assistance to enhance preoperative planning, intraoperative screening, and postoperative monitoring. Overall, AI carries promising potential to advance the field of OMFS and generate novel solution possibilities for persisting clinical challenges. Herein, this review provides a comprehensive summary of AI in OMFS and sheds light on future research efforts. Further, the advanced analysis of complex medical imaging data can support surgeons in preoperative assessments, virtual surgical simulations, and individualized treatment strategies. AI also assists surgeons during intraoperative decision-making by offering immediate feedback and guidance to enhance surgical accuracy and reduce complication rates, for instance by predicting the risk of bleeding.

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.

The impact of passive alveolar molding vs. nasoalveolar molding on cleft width and other parameters of maxillary growth in unilateral cleft lip palate.

OBJECTIVE: Passive alveolar molding (PAM) and nasoalveolar molding (NAM) are established presurgical infant orthodontic (PSIO) therapies for cleft lip palate (CLP) patients. PAM guides maxillary growth with a modified Hotz appliance, while NAM also uses extraoral taping and includes nasal stents. The effects of these techniques on alveolar arch growth have rarely been compared. MATERIAL AND METHODS: We retrospectively compared 3D-scanned maxillary models obtained before and after PSIO from infants with unilateral, non-syndromic CLP treated with PAM (n = 16) versus NAM (n = 13). Nine anatomical points were set digitally by four raters and transversal/sagittal distances and rotations of the maxilla were measured. RESULTS: Both appliances reduced the anterior cleft, but NAM percentage wise more. NAM decreased the anterior and medial transversal width compared to PAM, which led to no change. With both appliances, the posterior width increased. The alveolar arch length of the great and small segments and the sagittal length of the maxilla increased with PAM but only partially with NAM. However, NAM induced a significant greater medial rotation of the larger and smaller segment compared to PAM with respect to the lateral angle. CONCLUSIONS: NAM and PAM presented some significant differences regarding maxillary growth. While NAM reduced the anterior cleft and effectively rotated the segments medially, PAM allowed more transversal and sagittal growth. CLINICAL RELEVANCE: The results of this study should be taken into consideration when to decide whether to use PAM or NAM, since they show a different outcome within the first few months. Further studies are necessary regarding long-term differences.

Mandibular reconstructions with free fibula flap using standardized partially adjustable cutting guides or CAD/CAM technique: a three- and two-dimensional comparison.

Background: Mandibular reconstruction with the fibula free flap (FFF) is performed freehand, CAD/CAM-assisted, or by using partially adjustable resection/reconstruction aids. The two latter options represent the contemporary reconstructive solutions of the recent decade. The purpose of this study was to compare both auxiliary techniques with regard to feasibility, accuracy, and operative parameters. Methods and materials: The first twenty consecutively operated patients requiring a mandibular reconstruction (within angle-to-angle) with the FFF using the partially adjustable resection aids between January 2017 and December 2019 at our department were included. Additionally, matching CAD/CAM FFF cases were used as control group in this cross-sectional study. Medical records and general information (sex, age, indication for surgery, extent of resection, number of segments, duration of surgery, and ischemia time) were analyzed. In addition, the pre- and postoperative Digital Imaging and Communications in Medicine data of the mandibles were converted to standard tessellation language (.stl) files. Conventional measurements - six horizontal distances (A-F) and temporo-mandibular joint (TMJ) spaces - and the root mean square error (RMSE) for three-dimensional analysis were measured and calculated. Results: In total, 40 patients were enrolled (20:20). Overall operation time, ischemia time, and the interval between ischemia time start until end of operation showed no significant differences. No significant difference between the two groups were revealed in conventional measurements of distances (A-D) and TMJ spaces. The Δ differences for the distance F (between the mandibular foramina) and the right medial joint space were significantly lower in the ReconGuide group. The RMSE analysis of the two groups showed no significant difference (p=0.925), with an overall median RMSE of 3.1 mm (2.2-3.7) in the CAD/CAM and 2.9 mm (2.2-3.8) in the ReconGuide groups. Conclusions: The reconstructive surgeon can achieve comparable postoperative results regardless of technique, which may favor the ReconGuide use in mandibular angle-to-angle reconstruction over the CAD/CAM technique because of less preoperative planning time and lower costs per case.

Infantile human labial glands: Distribution of aquaporins and claudins in the context of paracellular and transcellular pathways.

Human labial glands consist of saliva-secreting cells which are formed by serous and predominantly mucous glandular cells. The following excretory duct system converts the isotonic saliva into a hypotonic fluid. Liquids are transported across the membrane of epithelial cells by paracellular or transcellular mode of action. We studied aquaporins (AQP) and tight junction proteins in the endpieces and duct system of human labial glands of 3-5-month-old infants for the first time. AQP1, AQP3, and AQP5 represent the transcellular transport; tight junction proteins like claudin-1, - 3, - 4, and - 7 regulate the permeability of the paracellular pathway. Specimens of 28 infants were included in this study and analyzed histologically. AQP1 was present in myoepithelial cells and in endothelial cells of small blood vessels. AQP3 showed basolateral plasmamembrane localization in glandular endpieces. AQP5 was localized at the apical cytomembrane in serous and mucous glandular cells and at the lateral membrane in serous cells. Ducts remained unstained with the antibody to AQP1, AQP3, and AQP5. Claudin-1, - 3, - 4, and - 7 were expressed mainly in the lateral plasmamembrane of serous glandular cells. In the ducts, claudin-1, - 4, and - 7 were detected at the basal cell layer, claudin-7 also at the lateral cytomembrane. Our findings provide new insights into the localization of epithelial barrier components necessary for regulating saliva-modification in infantile labial glands.

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.

Preoperative Peroneal Artery Perforator Mapping Using Indocyanine Green Angiography: A Prospective Clinical Trial.

BACKGROUND: Perforator imaging is a prerequisite in preoperative planning of the peroneal perforator flap and the fibula skin island. Although reports indicate that indocyanine green angiography assessment method might be advantageous over conventional ultrasound-based techniques (i.e., Doppler and color duplex), in practice, clear evidence is lacking. Thus, a comparative assessment of the utility of indocyanine green angiography and ultrasound-based techniques in the identification of suitable lower leg skin perforators was performed. METHODS: A prospective clinical cohort study with a series of 12 consecutive patients was conducted to assess indocyanine green angiography, Doppler ultrasound, and color duplex ultrasound techniques for preoperative perforator detection in the lower leg before free fibula flap harvest. Anatomical dissection served as a reference. Parameters measured were perforator spatial distance to the reference (precision), operative time expenditure, and ease of device usage for assessment/outcomes. RESULTS: This study included 12 patients, with a total of 27 perforators. Exhibition of technique sensitivity and positive predictive values were as follows: indocyanine green angiography, 93 percent and 100 percent; Doppler ultrasound, 82 percent and 82 percent; and color duplex ultrasound, 89 percent and 86 percent, respectively. With regard to the indocyanine green angiography technique, the distance to the actual perforator location was significantly shorter, which aided detection and lesser time expenditure during operation. CONCLUSIONS: The indocyanine green angiography technique proved to have high precision, sensitivity, positive predictive value, and easy-to-use capabilities because of its exceptional spatial and temporal information, compared to the conventional, ultrasound-based techniques. Therefore, indocyanine green angiography is superior for preoperative perforator imaging of the lateral lower leg. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis.

BACKGROUND: Mandibular reconstruction is conventionally performed freehand, CAD/CAM-assisted, or by using partially adjustable resection aids. CAD/CAM-assisted reconstructions are usually done in cooperation with osteosynthesis manufacturers, which entails additional costs and longer lead time. The purpose of this study is to analyze an in-house, open-source software-based solution for virtual planning. METHODS AND MATERIALS: All consecutive cases between January 2019 and April 2021 that underwent in-house, software-based (Blender) mandibular reconstruction with a free fibula flap (FFF) were included in this cross-sectional study. The pre- and postoperative Digital Imaging and Com munications in Medicine (DICOM) data were converted to standard tessellation language (STL) files. In addition to documenting general information (sex, age, indication for surgery, extent of resection, number of segments, duration of surgery, and ischemia time), conventional measurements and three-dimensional analysis methods (root mean square error [RMSE], mean surface distance [MSD], and Hausdorff distance [HD]) were used. RESULTS: Twenty consecutive cases were enrolled. Three-dimensional analysis of preoperative and virtually planned neomandibula models was associated with a median RMSE of 1.4 (0.4-7.2), MSD of 0.3 (-0.1-2.9), and HD of 0.7 (0.1-3.1). Three-dimensional comparison of preoperative and postoperative models showed a median RMSE of 2.2 (1.5-11.1), MSD of 0.5 (-0.6-6.1), and HD of 1.5 (1.1-6.5) and the differences were significantly different for RMSE (p < 0.001) and HD (p < 0.001). The difference was not significantly different for MSD (p = 0.554). Three-dimensional analysis of virtual and postoperative models had a median RMSE of 2.3 (1.3-10.7), MSD of -0.1 (-1.0-5.6), and HD of 1.7 (0.1-5.9). CONCLUSIONS: Open-source software-based in-house planning is a feasible, inexpensive, and fast method that enables accurate reconstructions. Additionally, it is excellent for teaching purposes.

NAM-help or burden? Intercultural evaluation of parental stress caused by nasoalveolar molding: a retrospective multi-center study.

OBJECTIVES: Nasoalveolar molding (NAM) was developed to facilitate easier treatment and better outcomes for cleft lip and palate (CLP) patients. The aim of this study was to investigate the parental burden and possible intercultural differences of this treatment modality, which is often argued to burden parents to an extraordinary amount. MATERIALS AND METHODS: Standardized questionnaires (available in English, Mandarin, and German) with 15 non-specific and 14 NAM-specific items to be retrospectively answered by Likert scales by parents of unilateral CLP patients with completed NAM treatment. RESULTS: The parents of 117 patients from two treatment centers in Taiwan and Germany were included. A very high level of overall satisfaction was found in both countries with significant intercultural differences in prenatal parent information, feeding problems, dealing with 3rd party's perception, and experienced personal effort. CONCLUSION: NAM is an effective treatment tool for children's CLP deformities and their caregivers in overcoming the feeling of helplessness. Intercultural differences may be due to infrastructural reasons, cultural attitudes and habits, or different public medical education. CLINICAL RELEVANCE: In addition to facilitating easier surgical treatment, NAM can be seen as a powerful coping strategy for parents dealing with a CLP deformity of their child and does not seem to burden them extraordinarily.

Comparative Photographic, Retrospective Analysis of Nonsyndromic Cleft Noses Treated with or without NAM.

BACKGROUND: Long-term results and efficacy of nasoalveolar molding (NAM) on the perinasal region are reported controversially in the literature. With this study, we demonstrate our experiences, contribute to the ongoing discussion, and describe our decision-making when NAM is indicated or not. METHODS: Conventional pre- and postinterventional photographs of patients with nonsyndromic unilateral and bilateral cleft lip and palate (UCLP and BCLP) were analyzed. The 2 independent raters were blinded to therapy (NAM versus non-NAM), and 7 parameters were measured. Intraclass correlation coefficient for intra- and interrater reliability was calculated. The Mann-Whitney U test was performed to compare therapy- and appearance-matched pairs. Finally, 30 specialists in cranio-maxillofacial surgery performed a subjective, blinded rating of matched NAM and non-NAM cases. RESULTS: Thirty-six patients, 16 UCLP and 20 BCLP, were enrolled. The intraclass correlation coefficients for intra- and interrater reliability were excellent for all measurements, except for nasal sill (0.77 intrarater and 0.80 interrater). Height-to-width ratio (P = 0.012) was significantly different in the comparison of non-NAM and NAM-treated severe cases with UCLP. Thirty blinded raters evaluated NAM-treated cases with severe UCLP better than matched non-NAM cases. Non-NAM-treated cases with moderate UCLP and BCLP were rated better than matched NAM cases. CONCLUSIONS: Children with severe UCLP may benefit from NAM therapy in the sense of better symmetry and a more homogenous appearance. Patients with moderate UCLP and BCLP did not benefit, and the risk of the burden of care increased.

Bone volume change following vascularized free bone flap reconstruction of the mandible.

BACKGROUND: Bone volume changes following vascularized bone flaps and possible confounding factors over time are described in the literature with some controversy. The purpose of this study was to evaluate the bone volume behavior of two frequently used free flaps. MATERIALS AND METHODS: Computed tomography (CT) scans were examined with regard to bone volume using the software program ITK-SNAP for all patients who required mandibular reconstruction with a free fibula flap (FFF, conventionally vs assisted by computer-aided design/computer-aided manufacturing (CAD/CAM)) or iliac crest flap (DCIA) following mandibular resection because of benign or malign processes, between August 2010 and August 2015. Clinical data, complication rates, and CT scans were analyzed retrospectively. Additionally, complication rates (microvascular revision, flap loss, postoperative fistula or dehiscence, and postoperative bone exposure) were compared within early (≤30 days), late (31st-100th day), and overall (≤100th day) postoperative time intervals. RESULTS: 113 cases, comprizing 89 FFF and 24 DCIA cases, were included. FFF showed superior bone volume behavior over the DCIA flap. Multivariable regression models assessed the relationships between the following and bone volume behavior: interval between operation and CT scan (p < 0.683), age (p = 0.004), gender (p = 0.006), BMI (p = 0.400), adjuvant radiation therapy (p = 0.334), reconstruction with DCIA flap (p < 0.0001), number of segments (p = 0.02), and incidence of dental implant insertion (p = 0.45). CONCLUSIONS: The bone volume of FFFs remains stable. DCIA flaps show a higher bone volume reduction, but the postoperative course might be associated with fewer complications. Time interval between operation and CT scan, age, gender, reconstruction with DCIA flap, and number of fibula segments contributed significantly to bone volume behavior.

Comparison between Different Perforator Imaging Modalities for the Anterolateral Thigh Perforator Flap Transfer: A Prospective Study.

BACKGROUND: Perforator imaging is routinely performed before perforator flap harvest. Hand-held Doppler (hhD) and color duplex ultrasonography (CDU) are currently the most popular radiation-free methods for this purpose that can be applied by the surgeon alone. The aim of this study was to compare the accuracy, reliability, and feasibility of hhD and CDU with indocyanine green angiography (ICGA) in the anterolateral thigh perforator flap (ALTPF). METHODS: All consecutive ALTPF procedures between May 2017 and April 2018 were included in this prospective study. The perforators were visualized by three investigators independently and randomized, applying hhD, CDU, and ICGA. The presence and the distance to the identified perforator were registered. Further, body mass index (BMI), American Society of Anesthesiologists-status, and the patient's history regarding smoking, alcohol use, and diabetes mellitus were registered alongside gender and age to analyze possible confounders. RESULTS: A total of 12 patients were enrolled with a median age of 67 (52-87) years. In total, 30 perforators were detected intraoperatively as well as with the ICGA. The latter visualized the perforators significantly more precisely than hhD and CDU (p < 0.001 and p = 0.001). The sensitivity and positive predictive value were 67 and 62% for hhD, 73 and 64% for CDU, and 100 and 100% for ICGA, respectively. CONCLUSION: According to this study, ICGA visualized perforators more accurately than the standard methods hhD and CDU. Further, it was associated with the highest sensitivity and positive predictive value. ICGA consistently delivered excellent results, whereas hhD and CDU showed variability.

Author Correction: A semi-automated virtual workflow solution for the design and production of intraoral molding plates using additive manufacturing: the first clinical results of a pilot-study.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Identifying perioperative volume-related risk factors in head and neck surgeries with free flap reconstructions - An investigation with focus on the influence of red blood cell concentrates and noradrenaline use.

INTRODUCTION: The amount of fluids administered intraoperatively seems to influence the postoperative outcome, and especially the transfusion of red blood cell concentrates (RBC) are known to have an increased risk of postoperative complications. This prospective study focuses on patients planned with microvascular free flap reconstruction and investigates the effect of various types and amounts of volumes given intraoperatively and on the intensive care unit with regard to overall postoperative complications. MATERIAL AND METHODS: In this prospective study, 52 consecutive patients planned for reconstruction with microvascular free flaps were included. Intraoperatively administered volumes including blood products were documented by the anesthesiologists as well as volumes given during the intensive care unit stay. Postoperative complications were registered for the entire hospital stay. Statistical analysis was carried out correlating the amount and type of volumes with the incidence of postoperative complications. RESULTS: The intraoperative use of RBC showed a close to statistically significant increased risk of postoperative complications (mean/SD concentrates: 0.5/1.1 [no complications] vs. 1.0/1.4 [complications], p = 0.058). In a multivariate analysis with stepwise selection the use of human albumin, gelatin, or Ringer's acetate showed no correlation with complications. The overall blood loss, however, had no significant influence on the incidence of complications (mean/SD ml: 1187/761 [no complications] vs. 1004/600 [complications], p = 0.37). The use of noradrenalin during reconstructive surgeries with microvascular flaps bears statistically no increased risk of failure (mean/SD µg/kg/min: 36/23 [no flap loss] vs. 22/15 [flap loss], p = 0.289) or complications (mean/SD µg/kg/min: 34/22 [no complications] vs. 35/23 [complications], p = 0.807). CONCLUSION: In our investigation, the use of crystalloids and colloids seems to have no influence on the postoperative outcome, but the use of RBC may have an increased overall incidence of postoperative complications. A careful hemostasis to limit the use of RBC remains essential despite available options of substitutions. The use of infusion-pump-administered noradrenaline seems valuable to sustain a stable circulation during surgeries with microvascular free flaps and may have no negative impact on postoperative complications.

Simultaneous, radiation-free registration of the dentoalveolar position and the face by combining 3D photography with a portable scanner and impression-taking.

OBJECTIVES: Simultaneous, radiation-free registration of the teeth and the upper and lower jaw positions in relation to the extraoral soft tissue could improve treatment planning and documentation. The purpose of this study is to describe a workflow to solve this form of registration and surface acquisition with a mobile device. METHODS: Facial scans of ten healthy participants were taken using a blue-light LED 3D scanner (Artec® Space Spider; Artec® Group; Luxembourg). An impression of the maxillary dentoalveolar arch was taken simultaneously to the 3D photo using a modified impression tray with two different extraoral registration geometries (sphere vs. cross). Following, an impression of the mandibular dentoalveolar arch was taken once. Both impressions were scanned with the 3D scanner. All resulting standard tesselation language (.stl) files of the geometries were compared to the original, virtual .stl files and the root mean square errors (RMSE) were calculated for each surface (Artec Studio 13 Professional × 64; Artec® Group; Luxembourg) to determine which geometry serves as a better reference for intra-extraoral registration. RESULTS: The RMSE between the original geometries and the scanned counterfeits were statistically lower for spherical geometries (p < 0.008). Once scanned and aligned, both geometries enabled an alignment of the intra- and extraoral scan. However, the spherical geometries showed virtually better results without significance (p = 0.70). CONCLUSIONS: The presented study provides a radiation-free solution for simultaneous dentoalveolar correlations in relation to the extraoral soft tissue. Spherical geometries achieved more precise and easier intra-extraoral alignments using the applied mobile 3D scanner and workflow.

The absolute and relative effects of presurgical nasoalveolar moulding in bilateral cleft lip and palate patients compared with nasal growth in healthy newborns.

BACKGROUND: This study investigated the efficiency of nasoalveolar moulding (NAM) in patients presenting with bilateral cleft lip and palate (BCLP). It focused explicitly on nasal outcome and therefore made comparisons with healthy age-matched infants with normal nasal development. METHODS: Nasal impressions from 19 BCLP patients were analysed at the beginning and at the end of NAM treatment. In addition, nasal impressions from 32 healthy newborns were taken monthly for 4 months. The casts were digitalized and analysed, using defined anatomic landmarks, by two independent observers. Initial values were compared with outcome parameters at the end of NAM therapy and with the healthy cohort. RESULTS: NAM significantly elongated the columella in BCLP patients, with an increase of 106.5% versus 14.5% in healthy newborns. Nostril height showed significant expansion from 4.2 mm to 5.6 mm on the right side, and from 4.3 mm to 6.2 mm on the left side. CONCLUSION: NAM significantly elongated columella length and increased nostril height. The comparison with healthy newborns showed the effectiveness of early cartilage moulding. Detailed knowledge about absolute and relative early nasal growth was gained. However, despite highly effective NAM treatment in BCLP, nasal dimensions will not reach healthy proportions.

Prenatal intrauterine maxillary development - An evaluation with three-dimensional ultrasound.

OBJECTIVES: The aim of this prospective study was to investigate normal fetal maxillary development with volume ultrasound during the prenatal phase, for a better estimation of maxillary growth processes. METHODS: Some 210 3D volumes were obtained in two measurement series from 38 healthy women (gestational age: 19+2 to 31+4 weeks) using a GE Voluson™ E10 ultrasound system. Maxillary length and width were determined in the axial and sagittal planes. Clearly defined, reproducible landmarks were used for measurements. The results were correlated with gestational age and compared with previously reported studies. RESULTS: Total maxillary length ranged from 10.30 to 24.75 mm, total maxillary width from 13.65 to 37.30 mm in an observation period during the second trimester, with high reproducibility for all landmarks. All evaluation results showed steep growth with exponential character. Length growth was determined to be more dominant than width growth. Intra-rater correlation was evaluated to be almost perfect (ICC (3) > 0.8). CONCLUSION: This study presents measurements of physiological fetal maxillary development. The defined landmarks proved to be representative for further investigations. This study serves as a baseline for a better understanding of fetal maxillary growth processes, and may be useful for standardising detection of malformations or intrauterine growth restrictions.