The effect of combined surgery and physiotherapy on the facial asymmetry in patients with congenital muscular torticollis: a retrospective cohort study.

The aim of this study was to assess the influence of surgical therapy, intraoperative evaluation, and immediate physiotherapy on the facial asymmetry of patients with congenital muscular torticollis (CMT). Patients who underwent a combination of unipolar sternocleidomastoid muscle release with perioperative physiotherapy between 2014 and 2020 in the Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen were enrolled. Three-dimensional photographs of the face acquired 2 months preoperatively and 1.5-2 years postoperatively were assessed. Based on 43 patients, there was a significant improvement in the asymmetry indices (angles between bilateral exocanthion, bilateral cheilion, and nasion-gnathion lines): mean ± standard deviation reductions in indices (Ex-Ex)-(Ch-Ch), (Ex-Ex)-(Na-Gn), and (Ch-Ch)-(Na-Gn) of 0.88 ± 1.08° (P < 0.001), 1.04 ± 1.26° (P < 0.001), and 0.21 ± 1.06° (P = 0.024), respectively. Analysis of covariance (ANCOVA) showed that intervention at an early age (P = 0.017) and left-sided torticollis (P = 0.030) were associated with a significantly greater improvement in the facial asymmetry. This study found that the use of combined surgery and physiotherapy reduced the facial asymmetry of patients with CMT at 2 years postoperatively. Early intervention and left-sided torticollis were associated with a greater improvement in the facial asymmetry. This indicates that attention should be given to early intervention and right-sided CMT cases postoperatively.

Three-dimensional stereophotogrammetry measurement of facial asymmetry in patients with congenital muscular torticollis: a non-invasive method.

The aim of this study was to evaluate three-dimensional (3D) stereophotogrammetry based methods for measuring craniofacial asymmetry in patients with congenital muscular torticollis (CMT). This study focused on the differences in craniofacial asymmetry in CMT patients compared with a healthy control group using 3D photographs. The difference in facial asymmetry between the CMT group and control group was measured using two methods to analyse facial asymmetry in distinct anatomical regions: (1) mirroring and surface-based registration to analyse the overall facial asymmetry; (2) the 'coherent point drift' based method. Thirty-one patients with CMT and 84 controls were included in the study. A statistically significant difference was found between the CMT patients and a healthy control group. The measured facial asymmetry for the CMT group was 1.71±0.66mm and for the controls 0.46±0.14mm (P<0.05). A significant difference was found in surface ratio for the cheek, nose and the forehead region (P<0.05). With its minimal invasive character, 3D stereophotogrammetry is a useful tool in measuring the facial asymmetry associated with CMT and to quantify the treatment-induced facial changes. In the future 3D facial data could be used to create a ranking-scale to categorize the severity of facial asymmetry.

[Dental impression material left in patients with a palatal defect: a case series]. / Achterblijven van tandheelkundig afdrukmateriaal bij schisispatiënten met een palatumdefect.

Inattention while taking dental impressions of the upper jaw of patients with a palatal defect can lead to dental impression material being left behind. Two patients with a cheilognathopalatoschisis and a full arch prosthesis in the upper jaw were referred with complaints characteristic of chronic sinusitis and recurrent epistaxis, lasting several years. A facial cone beam computer tomogram revealed dental impression material left behind in the palatal defect and the nasal cavity. In the case of both patients, the foreign bodies were removed under general anaesthesia. One of the patients twice brought up a residual fragment of dental impression material left in the palatal defect after surgery.

Healing of bone defects in the goat mandible, using COLLOSS E and beta-tricalciumphosphate.

COLLOSS E, an equine extracellular matrix product containing native transforming growth factor beta1 and several bone morphogenetic proteins, has shown osteoinductive properties in ectopic sites. This study was set up to examine its properties in an orthotoptic site in conjunction with a beta-tricalciumphosphate (beta-TCP) scaffolding material. Thirty-two 17-mm circular defects in goat mandibles were filled with COLLOSS E, beta-TCP, COLLOSS E + beta-TCP, or left empty. After 9 weeks the results were quantified by micro-computed tomography and histology. The empty defects contained the highest percentage of new bone (62%). The beta-TCP scaffold resulted in 38% (p = 0.0029), the mixture of beta-TCP/COLLOSS E resulted in 36% (p = 0.0057), while the use of COLLOSS E alone resulted in 55% (not significant p = 0.34). These results show that addition of TCP did not result in the expected synergy with regard to the healing of the defect and seemed even to inhibit the healing process. On the other hand, the addition of COLLOSS E induced the formation of small islands of new bone, not connected to the defect edges. This was not observed in the specimens not containing COLLOSS E (4.61% of bone formation centrally in the defect vs. 0.56%; p = 0.042). In conclusion, the results of the present study are somewhat unexpected in that the empty defects showed the most bone ingrowth; however, this ingrowth was always connected to the defect edges. In contrast, the application of COLLOSS E with or without beta-TCP induced bone formation in the center of the defects also.

Analytical assessment of the osteoinductive material COLLOSSE.

In this study, the growth factors in COLLOSSE were analyzed, using ELISA tests, mass spectrometry, western blotting, and a 24-day cell culture experiment using osteoblast-like cells. The results of the ELISA testing, mass spectrometry, and western blotting all confirmed that TGF-beta1 was the main growth factor in COLLOSSE at 55 ng/mg. The results from the culture test showed that the cell proliferation, alkaline phosphatase activity, and matrix calcification were all drastically changed by the addition of COLLOSSE, mirroring the effects of addition of TGF-beta1. We conclude that COLLOSSE is not only a rich source of TGFbeta-1, but also contains the growth factors TGFbeta-2, BMP-2, BMP-3, BMP-7, IGF-1, and possibly VEGF. Other growth factors might be present in COLLOSSE, but were not identified due to inherent detection limits of the used ELISA and mass spectrometry techniques. The number of osteoinductive factors in COLLOSSE causes a synergistic effect, explaining the new bone formation found in previously described in vivo studies, with much lower growth factor concentrations when compared with recombinant BMPs.

[Bone substitutes, growth factors and distraction osteogenesis]. / Botsubstituten, groeifactoren en distractieosteogenese.

Up to the present time, bone transplants are commonly used to reconstruct bone defects. Recently, several bone substitutes have been suggested to overcome the disadvantages of the procedure of bone harvesting. However, research reveals that an autogenous bone graft is still the gold standard. To replicate the structure and function of natural bone, growth factors or even living, bone-forming cells can be added to enhance the formation of new bone. In that case, one speaks of cell-based tissue-substition. As an alternative distraction osteogenesis, a mechanical-based way of tissue engineering is suggested. In this procedure, tissue-generation takes place without the addition of external material. A combination of both tissue-substitution techniques, consisting of the addition of bone-replacement materials or growth factors during distraction osteogenesis, has also been evaluated in research on animals, although not with unequivocal results.

[The role of guidelines and systematic reviews in oral healthcare]. / De rol van richtlijnen en systematische literatuuroverzichten in de tandheelkundige zorgverlening.

Clinical practice guidelines are a very appropriate means of keeping up to date, effectively and efficiently, with knowledge on a specific clinical topic. These are a compilation of clinical expertise retrieved from daily practice, scientific evidence derived from journals and the opinions of patients, which together form the core of the treasury of ideas of evidence-based dentistry. The development of clinical practice guidelines should be carried out according to a strictly defined procedure. In this procedure systematic reviews of literature should be used. The Cochrane Collaboration is an organization that develops reliable systematic reviews. Clinical practice guidelines are an essential part of evidence-based dentistry. The evidence-based approach should be fully integrated in dental education and in daily dental practice. The establishment of a national centre for evidence-based development and implementation of dental clinical practice guidelines, in cooperation with other healthcare professionals, should have the highest priority, in order to maintain the quality of oral healthcare in professional hands.

Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults.

BACKGROUND: The prophylactic removal of asymptomatic impacted wisdom teeth is defined as the (surgical) removal of wisdom teeth in the absence of local disease. Impacted wisdom teeth have been associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gums- and alveolar bone disease, damage of the adjacent teeth, the development of cysts and tumours. Several other reasons to justify prophylactic removal have also been given. Wisdom teeth do not always fulfil a functional role in the mouth. When surgical removal is carried out in older patients the risk of more postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries the prophylactic removal of trouble-free wisdom teeth, either impacted or fully erupted, has long been considered as 'appropriate care'. Prudent decision-making, with adherence to specified indicators for removal, may reduce the number of surgical procedures by 60% or more. It has been suggested that watchful monitoring of asymptomatic wisdom teeth may be an appropriate strategy. OBJECTIVES: To evaluate the effect of prophylactic removal of asymptomatic impacted wisdom teeth in adolescents and adults compared with the retention of these wisdom teeth. SEARCH STRATEGY: The following electronic databases were searched:The Cochrane Oral Health Group Trials Register (4 August 2004), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 4 August 2004), PubMed (1966 to 4 August 2004), EMBASE (1974 to 4 August 2004). There was no restriction on language. Key journals were handsearched. An attempt was made to identify ongoing and unpublished trials. SELECTION CRITERIA: All randomised or controlled clinical trials (RCTs/CCTs) comparing the effect of prophylactic removal of asymptomatic impacted wisdom teeth with no-treatment (retention). DATA COLLECTION AND ANALYSIS: Assessment of relevance, validity and data extraction were conducted in duplicate and independently by three reviewers. Where uncertainty existed, authors were contacted for additional information about randomisation and withdrawals. A quality assessment of the trials was carried out. MAIN RESULTS: Only three trials were identified that satisfied the review selection criteria. Two were completed RCTs and both assessed the influence of prophylactic removal on late incisor crowding in adolescents. One ongoing RCT was identified, but the researchers were unable to provide any data. They intend to publish in the near future and information received will be included in updates. Although both completed trials met the inclusion criteria of the review, regarding participants characteristics, interventions and outcomes assessed, different outcomes measures were assessed which prevented pooling of data. AUTHORS' CONCLUSIONS: No evidence was found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults. There is some reliable evidence that suggests that the prophylactic removal of asymptomatic impacted wisdom teeth in adolescents neither reduces nor prevents late incisor crowding.