Third Molar Complications in the Elderly-A Matched-Pairs Analysis.

PURPOSE: The aim of this study was to evaluate the perioperative morbidity of third molar (3M) removal in elderly patients in an attempt to estimate the long-term future burden of 3M-related morbidity resulting from the postponement of 3M surgery to old age. MATERIALS AND METHODS: The study design was a retrospective matched-pair analysis comparing patients at least 65 years old (group A) with a control group of 15- to 20-year-old patients (group B). Age group was the predictor variable in this study. Outcome variables were general health status as defined by the modified Charlson score (MCS) and the American Society of Anesthesiologists (ASA) score, general surgical risks from antithrombotic or antiresorptive medication, and specific local surgical risks and complications. RESULTS: Patients in group A showed substantially more comorbidities as reflected in significantly higher MCS and ASA scores (P < .001). Older patients more frequently used antithrombotic agents (P < .001), had higher rates of ankylosis (P < .001) and nerve proximity (P < .001), and showed significantly more in intra- and postoperative complications (P < .001), thus resulting in longer operations and a substantially longer hospital stay (P < .001). CONCLUSION: Within the limits of a non-epidemiologic approach, this study showed a substantially greater burden of morbidity and substantially worse outcome of 3M surgery in older adults compared with young adults. For the medical risks of an aging population, the present data suggest a veritable burst of 3M-associated morbidity when surgery is shifted to late adulthood.

Scope and limitations of methods of mandibular reconstruction: a long-term follow-up.

Surgical treatment of cancers of the oral cavity often requires resection of the mandible, which sacrifices continuity, thereby implying considerable loss of function and aesthetics. The aim of the present study was to compare different methods of mandibular reconstruction for long-term results, complications, and factors associated with failure. During the 10-year period (1995-2005), 102 patients (73 men and 29 women, mean age 55 years, range 11-83) had a continuity resection of the mandible as described by Jewer et al. as follows: lateral continuity defect (n=53), central/lateral continuity defect (n=24), lateral/central/lateral continuity defect (n=14), central continuity defect (n=6), hemimandibular continuity defect (n=4) and central/hemimandibular continuity defect (n=1). The gap in the mandible was bridged with a titanium reconstruction plate in 73 patients, four of whom required a temporomandibular joint prosthesis. In 29 patients the mandibles were reconstructed with free autologous bone grafts fixed with miniplates. The overall 1-year success rate was 64%; 66% for the 73 patients who had miniplate/bone fixation and 63% in the 29 whose defects were bridged with a reconstruction plate. Complications were associated with the reconstruction plate in 39%. The most common complications were extraoral exposure (16%), intraoral exposure (10%), loose osteosynthesis screws (5%), fractures of the reconstruction plate (5%), and extra/intraoral exposure (1%). All fractures were noted at least 6 months postoperatively. There was no increased risk (p=0.67) depending on the osteosynthesis device used (miniplate or reconstruction plate). The risk of failure of the reconstruction plate was significantly higher in men (p=0.002) and smokers (p=0.004), whereas no increased risk was apparent for the anatomical site of the defect. Radiation reduced the 1-year success rate from 64% to 45% but not significantly so (p=0.67). There were no significant differences between the reconstruction methods. Alloplastic reconstruction devices are the treatment of choice for many patients.

Bleeding complications after oral surgery in outpatients with compromised haemostasis: incidence and management.

UNLABELLED: PURPOSE AND RESULTS: The aim of this prospective study was to determine the incidence of postoperative bleeding after oral surgery under local anaesthesia performed in outpatients with haemostatic disorders within a 5-year period (2003-2007). One hundred twenty one (70 males, 51 females) out of 2,056 outpatients with different haemostatic disorders (acquired or hereditary) were included in this study. The following data were recorded: medical history and general condition; medications; indication for the surgical procedure; specification of local anaesthesia; applied surgical techniques, considering the kind of haemostatic disorder; and peri- or postoperative bleeding complications. Postoperative bleeding was observed in 12 patients (9.9%). In three cases, inpatient treatment became necessary. The management of two patients with a haemostatic disorder (von Willebrand s disease and haemophilia A) is presented in short case reports. CONCLUSION: In a heterogeneous group of 121 outpatients with known haemostatic disorders, a combination of a few haemostatic agents with appropriate operative technique enables an effective wound management. In cases of failed local interventions after postoperative bleeding, further diagnostic investigations are required.

Micromorphometrical analysis of conventional osteotomy techniques and ultrasonic osteotomy at the rabbit skull.

OBJECTIVES: The ultrasonic osteotome, which was recently introduced, is an alternative to conventional methods of osteotomy. The aim of the present study was to establish the differences between three osteotomy techniques and to perform a quantitative roughness analysis of the osteotomized bone surfaces. MATERIALS AND METHODS: Fresh bony samples of standardized size were taken from the rabbit skull. The techniques used were as follows: reciprocate micro-saw, Lindemann bur, ultrasonic osteotome with the two insert tips OT6 (rough) and OT7 (fine). The prepared surfaces were examined by light microscopy, environmental surface electron microscopy (ESEM) and by confocal laser scanning microscopy (CLSM). RESULTS: It was difficult to distinguish between cortical and cancellous bone after using the conventional osteotomy technique. The ultrasonic technique preserved the original structure of the bone. The values observed for superficial roughness were as follows: 3.97 microm (micro-saw), 5.7 microm (Lindemann bur), 2.48 microm (OT7) and 3 microm (OT6). There were statistical differences between the values of the bur and insert tip OT6 (P=0.015) as well as between the bur and insert tip OT7 (P=0.003). CONCLUSIONS: In the present study micromorphological differences after using various osteotomy techniques could be clearly identified.

[Light microscopic examination of rabbit skulls following conventional and Piezosurgery osteotomy]. / Auflichtmikroskopische Untersuchungen an der Kaninchenkalotte nach ultraschallgestützter und konventioneller Osteotomie.

INTRODUCTION: The novel ultrasonic osteotomy technique (Piezosurgery) is an alternative to conventional osteotomy devices. The aim of the present study was to carry out morphological comparison of the bone surface using conventional osteotomy techniques in comparison to the rather new ultrasonic osteotomy technique by means of a reflected-light microscopic examination. MATERIALS AND METHODS: Following the sacrifice of 12 rabbits, 24 standardized bone samples were removed from the skull. The osteotomy devices used were a rotating instrument (Lindemann bur), an oscillating micro-saw, and an ultrasonic osteotomy device (Piezosurgery) with insert tips OT6 and OT7. The times needed for osteotomy were measured. The bone surfaces were examined using a reflected-light microscope with a magnification of 40x and 100x. RESULTS: Osteotomy with Piezosurgery is significantly more time consuming than osteotomy with conventional methods (p<0.05). Following osteotomy with the ultrasonic device, the reflected-light microscopic examinations of the unmodified bone samples revealed typical bone structure of the calvaria, including compacta externa, diploe and compacta interna. On the contrary, following osteotomy with the conventional devices, the diploe structure presented distinct modifications. The cancellous spaces were filled with bone debris, and the cancellous structure was demolished. The samples prepared by the micro-saw technique showed a superficially condensed and grooved surface. CONCLUSION: In the present study, well-defined differences were observed following osteotomy with conventional devices and osteotomy with the ultrasonic device. The integrity of the bony structure observed after the ultrasonic technique could benefit the bone healing process. Further studies dealing with the bone healing process after using different osteotomy techniques are recommended.

Long-term outcomes after treatment of condylar fracture by intraoral access: a functional and radiologic assessment.

PURPOSE: The aim of the present study was to investigate radiographic and functional long-term results after condylar fractures have been reduced by an exclusively intraoral surgical approach. PATIENTS AND METHODS: A total of 25 (21 male, 4 female) consecutive patients with 30 condylar process fractures were retrospectively investigated. Clinical follow-up was performed in 19 patients (16 male, 3 female) with a total of 24 fractures. Median postoperative follow-up time was 19.7 months. Surgical indications followed specific parameters of fracture localization, dislocation, and ramus shortening. All patients were examined in accordance with the Research Diagnostic Criteria for Temporomandibular Dysfunction (RDC/TMD) and the Helkimo Index. Orthopantomograms (OPGs) were analyzed with use of the condylar morphologic scale (CMS), and mandibular ramus position and height were measured. RESULTS: Fractures were classified as condylar neck (n = 2) and basis fractures (n = 28), according to criteria of the Strasbourg Osteosynthesis Research Group (SORG). Mean age of patients was 33 years (standard deviation [SD], 13 yr). RDC/TMD measurements at follow-up showed a mean mouth opening of 48 mm (SD, 9), mandibular laterotrusion right of 11 mm (SD, 3.8), laterotrusion left of 10 mm (SD, 4.5), and protrusion with a mean of 5.83 mm (SD, 3). No joint clicking, weakness of the facial nerve, or joint or muscular pain was observed. Statistical analysis of the CMS showed significantly better postoperative ramus height (P < .05). CONCLUSION: Reduction achieved by this technique allows reconstruction of anatomic ramus height in combination with excellent functional results.