Soft tissue-based registration of intraoral scan with cone beam computed tomography scan.

The aim of this study was to evaluate a novel soft tissue-based method to register an intraoral scan (IOS) with a cone beam computed tomography (CBCT) scan. IOS and CBCT data were obtained from eight dentate patients (mean age 21±2 years; three male, five female) and 14 fully edentulous patients (mean age 56±9 years; eight male, six female). An algorithm was developed to create a soft tissue model of the CBCT scan, which allowed a soft tissue-based registration to be performed with the IOS. First, validation was performed on dentate jaws with registration of the palatal mucosal surface and accuracy evaluation at the level of the teeth. Second, fully edentulous jaws were registered using both the palatal and alveolar crest mucosal surfaces. Distance maps were created to measure the method accuracy. The mean registration error was 0.49±0.26mm for the dentate jaws. Registration of the fully edentulous jaws had a mean error of 0.16±0.08mm at the palate and 0.16±0.05mm at the alveolar crest. In conclusion, the high accuracy of this registration method may allow the digital workflow to be optimized when no teeth are available to perform a regular registration procedure.

[Oral and maxillofacial surgeons' satisfaction of the use of procedural sedation and/or analgesia (PSA) in the clinic]. / Tevredenheid van mka-chirurgen over gebruik procedurele sedatie in de kliniek.

Fear of orofacial interventions is a very common problem. Procedural sedation and/or analgesia (PSA) offers added value in reducing anxiety, pain and discomfort. At the Radboud University Medical Centre (Nijmegen, the Netherlands) PSA is conducted under the guidance of physician assistants, resulting in a high degree of patient satisfaction. In this study, the 115 surgeons' satisfaction with PSA procedures for outpatient orofacial surgical interventions was evaluated by means of questionnaires. The study's conclusion is that oral and maxillofacial surgeons are highly satisfied when PSA is administered to very anxious patients. The collaboration with the department of anaestesiology ensures that the outpatient interventions can be performed safely and efficiently by the oral and maxillofacial surgeon.

Digital surface scanning in flap perfusion.

Monitoring vascular perfusion of transferred tissue is essential in reconstructive surgery to recognize early flap failure. The aim of this study was to evaluate the ability of a digital surface scanner to detect vascular perfusion disorders through the monitoring of skin colour changes. A total of 160 surface scans of the forearm skin were performed with a TRIOS 3D scanner. Vascular compromise was simulated at different time-points by intermittent occlusion of the blood supply to the forearm skin (first the arterial blood supply and then the venous blood supply). Skin colour changes were examined according to the hue, saturation, and value colour scale. Colour differences were analysed with a paired t-test. Significant differences were observed between the colour of the normal skin and that of the vascular compromised skin (P<0.01). The surface scanner could distinguish between arterial occlusion and venous congestion (P<0.01). A digital surface scan is an objective, non-invasive tool to detect early vascular perfusion disorders of the skin.

[Patient satisfaction with procedural sedation in oral and -maxillofacial surgery]. / Patiënttevredenheid met procedurele sedatie in de mka-chirurgie.

Fear of treatment by an oral and maxillofacial (OMF) surgeon or the dentist is a widespread and deep-rooted phenomenon. A patient can be taught to cope with dental phobia by means of psychological, cognitive behavioural therapy, but in cases of invasive oral treatment, such therapy may be insufficiently effective. For these invasive procedures, sedation serves as an alternative treatment option. The department of Oral and Maxillofacial Surgery at the Radboud University Medical Centre in Nijmegen, the Netherlands, offers the possibility to utilise intravenous sedation with midazolam (Dormicum®) and remifentanil (Ultiva®). This results in a reduction in the experience of axiety and pain, which can lead to an anterograde amnesia for the invasive treatment. Procedural sedation and analgesia (PSA) for OMF surgery demonstrate a high level of patient satisfaction, and therefore offer a good alternative treatment to local and general anaesthesia.

Chronic temporomandibular joint pain: two cases of osteoid osteoma and a review of the literature.

Osteoid osteoma is a benign bone tumour with self-limiting growth potential occurring in any part of the body. Two rare cases of a pathologically proven osteoid osteoma invading the temporomandibular joint (TMJ) are reported herein. This article also reviews the cases of osteoid osteoma of the craniofacial complex reported in the English-language literature to date. Although the clinical presentation of osteoid osteoma in the jaw differs from that of osteoid osteoma in the more common locations, the radiographic features are similar. In both cases presented, computed tomography revealed a small round osseous lesion with sharp margins in the TMJ. Bone scintigraphy was performed in order to differentiate the lesions from other osseous lesions. Both patients underwent surgical excision of the lesion with immediate relief of the pain. The importance of early recognition of the clinical and imaging characteristics of an osteoid osteoma of the TMJ is emphasized, in order to prevent misdiagnosis and avoid discouraging therapies.

[Gout in the temporomandibular joint]. / Jicht in het temporomandibulaire gewricht.

A 76-year-old woman, with a medical history of diabetes mellitus and hypertension, presented herself to an oral and maxillofacial surgeon with a sudden pre-auricular swelling of the right temporomandibular joint. As a result of the atypical clinical appearance and signs of local destruction in the initial panoramic x-ray, a malign process was first eliminated from consideration. With the aid of extensive diagnostics and an open biopsy, the diagnosis of gout was established.