A modified pull-through approach with a pedicled bone flap for oral and oropharyngeal cancer resection: a feasibility study.

PURPOSE: Compromised swallowing, speaking, and local complications are the major disadvantages of established approaches to the posterior tongue and oropharynx. The mandibular split involves an esthetically unpleasant bipartition of the lower lip and is prone to bony non-union or sequestration. The conventional pull-through technique on the other hand lacks the secure reattachment of the lingually released soft tissues. METHODS: The feasibility of a new modified pull-through approach was tested on three anatomical specimens. CAD/CAM cutting guides were used to design a retentive bone flap to properly refixate the genioglossus and geniohyoid muscles after the procedure. The radiographic assessment and treatment planning was performed on 12 cadavers. The entire procedure was tested surgically via dissection in three of those cases. This procedure was then applied in a clinical case. RESULTS: Precise repositioning and dynamic compression of bony segments was possible reproducibly and without injury to adjacent structures. In all dissected cases, a median lingual foramen was found and in two cases vessels entering it could be dissected Radiologic anatomical landmarks were sufficient in all 12 cases to perform the clinical planning procedure. Clinically, the osteotomized segment demonstrated good blood supply and plateless repositioning was verified postoperatively via cone beam scan. CONCLUSION: The method presented is safe and easy to perform. Individual cutting guides improve the safety and accuracy of the procedure, potentially eliminating the need for osteosynthesis. We provide the anatomical and radiologic basis for clinical evaluation of this pedicled bone flap procedure and present the clinical application of this modified pull-through approach.

Prevalence of dental caries in children with congenital heart disease.

BACKGROUND: Congenital heart defects (CHD) affect about 8 out of 1000 births worldwide. Most of the patients reach adulthood and are exposed to an increased risk of endocarditis. Since bacteria already enter the bloodstream during everyday activities, oral hygiene is given special importance in the prevention of endocarditis. METHODS: In this study 81 boys (55.1%) and 66 (44.9%) girls with CHD received a dental exam and additionally an assessment using the DIAGNOdent® pen. This study group consisting of patients with CHD was matched with a healthy epidemiological control group in Germany. RESULTS: Eighty-one boys (55.1%) and 66 (44.9%) girls were examined. The mean age was 11 ± 4 years. 38.8% showed at least one untreated carious lesions. 37.4% had a dmft/DMFT ≥2 and thus represented a group with an increased caries risk. The dmft value was 2.12 ± 1.25 in the age group 3-6 year olds. In the group of the 7-12 year old patients the DMFT/dmft was 2.06 ± 2.27, whereas DMFT in 13-17 year olds was at 2.12 ± 1.58. However, children and adolescents with CHD had a higher DMF index than healthy children in the same age group. CONCLUSIONS: The present study reveals that more than one third of those examined have a dental condition in need of rehabilitation. In future, close interdisciplinary cooperation between pediatric cardiologists and dentists should ensure regular dental check-ups.

Prognostic value of lymph node involvement in oral squamous cell carcinoma.

OBJECTIVES: Different parameters have been identified in patients with oral squamous cell carcinomas (OSCC) that have a serious impact on survival, including residual tumour and extracapsular spread. Moreover, other factors, including the lymph node ratio (LNR) and lymph node yield (LNY), have been suggested as prognostic markers. MATERIAL AND METHODS: This retrospective study included patients diagnosed with OSCC and cervical lymph node metastases during the years 2010-2020. Patients' records were evaluated regarding lymph node status, final therapy regime, tumour recurrence, time to death, tumour association with death, disease-free survival (DSF), and overall survival (OS). RESULTS: In 242 patients with a mean age of 63.57 ± 11.24 years, treated either by selective neck dissection (SND; n = 70) or by modified radical neck dissection (MRND; n = 172), 5772 lymph nodes were detected. The LNR and LNY were identified as independent risk factors in OS and DFS. The optimal cut-off point for the LNY was ≥ 17 lymph nodes in the SND and ≥ 27 lymph nodes in the MRND group. The metastatic lymph node clearance (MLNC) was established as a score to relate the LNR and LNY to the extent of lymph node removal. Survival analysis showed statistically significant differences among score levels. CONCLUSIONS: As information about the extent of nodal dissection is excluded from LNR and LNY, we propose the use of a new scoring system comprising individual cut-off values for LNY and LNR with regard to the extent of neck dissection. CLINICAL RELEVANCE: MLNC might help to identify high-risk OSCC patients with metastatic lymph nodes.

Modified McLaughlin's Dynamic Muscle Support in the 21st Century? A Retrospective Study With a Prospective Follow-Up Analysis for Patients With Long Standing Facial Paralysis.

INTRODUCTION: Facial nerve paralysis can dramatically affect the life of a patient as it leads to significant alterations of the facial symmetry and functional limitations. Various methods exist including free neuromuscular flaps to reanimate patients suffering from uni- or even bilateral facial nerve paralysis. The more than 60-year-old technique described by McLaughlin continues to offer an alternative with distinct advantages for the individual patient. The present study aimed to evaluate clinical outcome and satisfaction of patients treated with a modified McLaughlin's Dynamic Muscle Support. MATERIALS AND METHODS: A total of 13 patients (mean age of 58.4 years) who received a modified McLaughlin's Dynamic Muscle Support due to uni- or bilateral long-standing facial paralysis were included. Medical records were reviewed retrospectively, and patients were contacted for additional follow-up. Patients who agreed to participate in the follow-up study were asked to answer a self-developed questionnaire. RESULTS: In all patients, a rehabilitation of facial symmetry with an improvement of the mimic expression could be achieved. Mean length of inpatient stay was 6.5 days and average duration of surgery was 121 minutes. No surgical site infection occurred. Mean follow-up was 23 months. Most of the patients were fully satisfied with the result and could experience functional and esthetic improvement.Patients who participated in the prospective follow-up study were very satisfied with the esthetic result and functional outcome. CONCLUSIONS: Even in times of advanced microsurgical techniques, McLaughlin's Dynamic Muscle Support appears to be a good alternative for the successful treatment of long-standing facial paralysis.

Retrospective Evaluation of NI-RADS for Detecting Postsurgical Recurrence of Oral Squamous Cell Carcinoma on Surveillance CT or MRI.

BACKGROUND. Imaging surveillance is important for the early diagnosis of recurrence after definitive treatment of oral squamous cell carcinoma (OSCC). The Neck Imaging Reporting and Data System (NI-RADS) includes a standardized template for surveillance imaging and categorizes probability of recurrence at the primary site and in the neck (cervical lymph nodes) by assigning categories of 1 (no evidence of recurrence), 2 (low suspicion, subdivided into 2a and 2b for the primary site), 3 (high suspicion), and 4 (definite recurrence). OBJECTIVE. The aim of this study was to determine the rate of locoregional and nodal OSCC recurrence stratified by NI-RADS category among patients undergoing surveillance CT or MRI. METHODS. This retrospective study included 158 patients enrolled in an institutional surveillance program after resection of OSCC with curative intent. A total of 503 contrast-enhanced CT or MRI examinations performed during surveillance were evaluated. Each examination was randomly assigned to one of four radiologists with expertise in head and neck imaging, who provided NI-RADS categories for the primary site and the neck (1006 assigned NI-RADS categories). NI-RADS performance in identifying recurrence was assessed by ROC curve analysis. All four readers evaluated 50 randomly assigned cases to determine interreader agreement by use of the Kendall W statistic. RESULTS. Cancer recurrence was confirmed in 7.6% (38/503) of cases for the primary site and in 6.2% (31/503) for the neck. For the primary site, recurrence rates were 1.0% in NI-RADS category 1, 7.1% in category 2a, 5.6% in category 2b, 66.7% in category 3, and 100.0% in category 4. For the neck, recurrence rates were 0.5% in category 1, 7.0% in category 2, 80.0% in category 3, and 100.0% in category 4. NI-RADS had AUC values of 0.934 for the primary site and 0.959 for the neck. Interreader agreement was 0.67 for the primary site and 0.81 for the neck. CONCLUSION. NI-RADS offers excellent discriminatory power in detection of OSCC recurrence, both for the primary site and the neck. CLINICAL IMPACT. Radiologists and maxillofacial surgeons should implement NI-RADS in surveillance regimens for postoperative OSCC to help detect recurrences in an effective and standardized manner using imaging.

Oxidative and Nitrosative Stress in Oral Squamous Cell Carcinoma.

INTRODUCTION: The incidence of oral squamous cell carcinoma (OSCC) shows a constant increase, while the long-term outcome remains poor over the last decades. Radical oxygen and nitrogen species (RONS) - initially released by carcinogens, such as alcohol and tobacco, and later maintained by the tumor microenvironment - appear to be strongly associated to chronic inflammation, tumor induction, progression, and metastatic spread. The aim of this study was to evaluate the role of oxidative and nitrosative stress in primary OSCC compared to healthy tissue specimens and to identify their impact on tumor carcinogenesis. MATERIALS AND METHODS: In this basic research study, tissue samples of 30 patients with primary OSCC were evaluated for the expression of pAKT, pERK, 3-NT, NOS1, NOS3, MAPK1, and IP-8 by immunohistochemistry and RT-PCR and compared to those of a healthy control group (n = 30). RESULTS: The results showed a significantly increased expression of pAKT (p < 0.001), pERK (p = 0.01), 3-NT (p = 0.039), NOS1 (p = 0.025), NOS3 (p = 0.046), and MAPK1 (p = 0.032) in OSCC tissue samples compared to healthy controls. CONCLUSION: The results of this study prove the tested stable degradation products to be suitable for the detection of RONS in OSCC. Moreover, the significantly increased expression underlines the role of RONS in carcinogenesis of OSCC, suggests specific mechanisms of detection, and anticipates supplementary research.

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.

Following in the footsteps of Hippocrates-interrelation between the incidence of odontogenic abscess and meteorological parameters.

OBJECTIVES: Although many physicians in daily practice assume a connection between odontogenic infections and meteorological parameters, this has not yet been scientifically proven. Therefore, the aim of the present study was to evaluate the incidence of odontogenic abscess (OA) in relation to outdoor temperature and atmospheric pressure. PATIENTS AND METHODS: An analysis of patients with an odontogenic abscess who presented at the emergency department within a period of 24 months was performed. Only patients who had not received surgical or antibiotic treatment prior to presentation and who lived in Berlin/Brandenburg were included. The OA incidence was correlated with the mean/maximum outdoor temperature and atmospheric pressure starting from 14 days before presentation. The statistical analysis was carried out using Poisson regression models with OA incidence as dependent and meteorological parameters as independent variables. RESULTS: A total of 535 patients (mean age 39.4 years; range 1 to 95 years) with 538 cases were included. Of these, 227 were hospitalized. The most frequent diagnosis was a canine fossa abscess. A significant association between mean (p = 0.0153) and maximum temperature (p = 0.008) on the day of the presentation and abscess incidence was observed. Furthermore, a significant correlation between OA incidence and maximum temperature 2 days before presentation was found (p = 0.034). The deviation of the mean temperature on the day of the presentation from the monthly mean temperature had a significant influence (p = 0.021) on the incidence of OA. In contrast to temperature, atmospheric pressure had no significant influence on the incidence of OA. CONCLUSION: This study supports a relationship between the incidence of odontogenic abscess and outdoor temperature, but not atmospheric pressure. A significantly higher frequency of patients with an OA presented at our emergency department on days with (comparably) low and high outdoor temperatures. Furthermore, a significant correlation between incidence and maximum temperature 2 days before presentation was found. CLINICAL RELEVANCE: The treatment of odontogenic infections has become a significant economic burden to public health care facilities. The results of this study may help to adapt the numbers of doctors/dentists on duty in relation to different weather conditions. In any case, it is an impetus to think outside the box.

Improved detection rates and treatment planning of head and neck cancer using dual-layer spectral CT.

PURPOSE: The aim of this study was to evaluate the advantages of dual-layer spectral CT (DLSCT) in detection and staging of head and neck cancer (HNC) as well as the imaging of tumour margins and infiltration depth compared to conventional contrast enhanced CT (CECT). MATERIALS AND METHODS: Thirty-nine patients with a proven diagnosis of HNC were examined with a DLSCT scanner and retrospectively analysed. An age-matched healthy control group of the same size was used. Images were acquired in the venous phase. Virtual monoenergetic 40keV-equivalent (MonoE40) images were compared to CECT-images. Diagnostic confidence for tumour identification and margin detection was rated independently by four experienced observers. The steepness of the Hounsfield unit (HU)-increase at the tumour margin was analysed. External carotid artery branch image reconstructions were performed and their contrast compared to conventional arterial phase imaging. Means were compared using a Student's t-test. ANOVA was used for multiple comparisons. RESULTS: MonoE40 images were superior to CECT-images in tumour detection and margin delineation. MonoE40 showed significantly higher attenuation differences between tumour and healthy tissue compared to CECT-images (p < 0.001). The HU-increase at the boundary of the tumour was significantly steeper in MonoE40 images compared to CECT-images (p < 0.001). Iodine uptake in the tumour was significantly higher compared to healthy tissue (p < 0.001). MonoE40 compared to conventional images allowed visualisation of external carotid artery branches from the venous phase in a higher number of cases (87% vs. 67%). CONCLUSION: DLSCT enables improved detection of primary and recurrent head and neck cancer and quantification of tumour iodine uptake. Improved contrast of MonoE40 compared to conventional reconstructions enables higher diagnostic confidence concerning tumour margin detection and vessel identification. KEY POINTS: • Sensitivity concerning tumour detection are higher using dual-layer spectral-CT than conventional CT. • Lesion to background contrast in DLSCT is significantly higher than in CECT. • DLSCT provides sufficient contrast for evaluation of external carotid artery branches.

Dental prevention and disease awareness in children with congenital heart disease.

OBJECTIVES: The importance of excellent oral health is known to be crucial in children with congenital heart diseases (CHD). Data about dental health and disease awareness is limited. This study aims to assess preventive measures taken to improve dental health in children with CHD and to gain insight into disease awareness and knowledge about the importance of oral health in children with CHD and to propose measures that could be taken. MATERIAL AND METHODS: Parents of 150 children with CHD were asked to complete a questionnaire containing specific questions about the preventive measures taken by the parents and dental and medical practitioners and their knowledge about underlying disease and the importance of oral health. RESULTS: Our results show an absence of information in parents concerning preventive measures and oral hygiene. Knowledge of the indications for antibiotic prophylaxis and for actually given medications was lacking. Preventive dental measures were not performed according to current guidelines. CONCLUSIONS: Knowledge of parents about the importance of oral health in children with CHD could be improved. However, specialized centers involving pediatric cardiologists and pediatric dentists could coordinate the education of parents at an early stage. Moreover, general dentists should be trained more frequently concerning the indications for antibiotic prophylaxis, in particular, and the dental care of children with chronic diseases, in general. Warning cards such as the heart pass should be issued to parents of children with CHD. CLINICAL RELEVANCE: The current study reveals the need for the structured training of medical and dental practitioners to support parents of children with CHD.

An Immunohistochemical Study on the Role of Oxidative and Nitrosative Stress in Irradiated Skin.

BACKGROUND/AIM: The effects of ionizing radiation through the generation of free radicals, reactive aldehydes, and other oxidative and nitrosative by-products account for skin injuries as side effects of radiation therapy (RT). This study aims to identify cellular pathways in oxidative and nitrosative stress in irradiated skin using well-established marker proteins in an immunohistochemical analysis. MATERIALS AND METHODS: Tissue specimens of 51 patients were obtained during operative access to the neck. Twenty patients (39.2%) received RT prior to the surgical intervention. Immunohistochemical analysis of stable degradation products of reactive oxygen and nitrogen species (RONS), 3-nitrotyrosine, 8-isoprostane, phosphorylated AKT (p-AKT), and phosphorylated extracellular signal-regulated kinase (p-ERK) was performed in specimens which were exposed to RT and those without a history of RT. RESULTS: Immunohistochemical staining showed a significantly increased expression of nitrotyrosine in superficial and basal epidermal regions of interest (ROI), p-AKT in all epidermal ROI, and p-ERK in all the investigated epidermal and dermal ROI, as well as in an overall analysis. No significance could be detected in immunostaining against isoprostane. DISCUSSION: This study summarizes the influence of RONS in RT. Moreover, a detailed histological analysis was able to identify epidermal ROI as a main starting point of RONS in irradiated skin. Even though the role of RONS in high-dose therapeutic radiation remains a subject for further research, these data underlines the crucial role of RONS in high-dose radiation.

Sympathomimetic effects of chronic methamphetamine abuse on oral health: a cross-sectional study.

BACKGROUND: Methamphetamine, a highly addictive sympathomimetic stimulant, is currently widely abused worldwide and has been associated with devastating effects on oral health, resulting in the term "meth mouth". However, "meth mouth" pathology is primarily based on case reports with a lack of systematic clinical evaluation. Therefore, we have conducted a systematic study to investigate (1) the pharmacological impact of methamphetamine on oral health with regard to saliva function, including the parameters saliva flow rate and total saliva production (ml/5 min) and the buffering capacity of saliva; (2) the contribution of the symptoms of bruxism and muscle trismus to potential oral health damage. METHODS: We assessed the data of 100 chronic methamphetamine abusers and 100 matched-pair comparison participants. Primarily, we conducted an anamnesis with all methamphetamine abusers with regard to saliva dysfunctions, jaw clenching and pain in the temporomandibular joint. Subsequently, in the first part of the clinical enquiry, we tested the saliva flow rate and the total saliva production (ml/5 min) by using the sialometry method and the buffer capacity of saliva by determining the pH-value. In the second part of the clinical enquiry, we evaluated bruxism symptoms with respect to generalized tooth attrition, dentine exposure and visible enamel cracks and examined a potential muscle trismus by measuring the maximal opening of the mouth. RESULTS: The majority of methamphetamine abusers reported a dry mouth (72 %) and jaw clenching (68 %). Almost half of all methamphetamine abusers experienced pain in the temporomandibular joint (47 %). With regard to the clinical findings, methamphetamine abusers showed significantly lower total saliva production (ml/5 min) (p < 0.001), lower pH-values of their saliva (p < 0.001) and more bruxism symptoms (p < 0.001). However, we found no relevant trismus symptoms on comparing the two groups (p > 0.05). CONCLUSIONS: The sympathomimetic effects of chronic methamphetamine abuse may lead to dry mouth and extensive bruxism and therefore can increase the risk for caries decay, periodontal lesions and tooth wear. Furthermore, a significant decline of saliva buffer capacity in methamphetamine abusers may trigger the risk for dental erosions. Methamphetamine abusers and practitioners should be aware of these symptoms.

A dental myth bites the dust--no observable relation between the incidence of dental abscess and the weather and lunar phase: an ecological study.

BACKGROUND: Anecdotal reports assert a relationship between weather and lunar activity and the odontogenic abscess (OA) incidence, but this relationship has not been validated. Therefore, the present study investigated the relationship between oral pain caused by OA and a variety of meteorological parameters and cyclic lunar activity. METHODS: The records of all dental emergency patients treated at the AllDent Zahnzentrum Emergency Unit in Munich, Germany during 2012 were retrospectively reviewed. Patients with oral pain who were diagnosed with OA and treated surgically (n = 1211) were included in the analysis. The OA incidence was correlated to daily meteorological data, biosynoptic weather analysis, and cyclic lunar activity. RESULTS: There was no seasonal variation in the OA incidence. None of the meteorological parameters, lunar phase, or biosynoptic weather class were significantly correlated with the OA incidence, except the mean barometric pressure, which was weakly correlated (rho = -0.204). The OA incidence showed a decreasing trend as barometric pressure increased (p < 0.001). On multiple linear regression, the barometric pressure accounted for approximately 4% of the OA incidence. CONCLUSION: There is no evidence supporting a correlation between the incidence of odontogenic abscess and the weather and lunar activities.

Histomorphologic characteristics of bisphosphonate-related osteonecrosis of the jaw.

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a known side effect of the therapy with bisphosphonates. No specific pathologic aspects or histological features are included in the most current definition. This study investigates characteristics of BRONJ with a special emphasis on histomorphologic aspects, evaluating the role of Actinomyces spp. as well as other disease-promoting factors in a formal pathogenetic context. METHODS: We investigated 23 patients (14 female, nine male; mean age: 66 ± 11.8 years) who received bisphosphonates with a gender- /age-matched control group. Tissue specimens were treated according to local standards and analyzed histologically. RESULTS: In 18 (78.3%) BRONJ cases, we found Actinomyces spp. colonies. Bone remodeling could be found in three specimens (13%). Eight specimens (34.8%) showed signs of epithelial proliferation. Analysis of dental treatment before the onset of BRONJ did not reveal significant differences (P > 0.20). In 10 patients (83%; P > 0.05) of the reported cases a relationship between dental treatment and the occurrence of a purulent bone necrosis could be observed. Statistically significant differences in thickness of trabeculae were detected between the two study groups (P = 0.04). CONCLUSIONS: This study demonstrates the important influence of the osteoblast-osteoclast balance in a histomorphologic analysis. Together with cofactors, which are able to trigger the onset of BRONJ, a new pathogenesis model was developed.

Quality of life after proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis.

PURPOSE: While ileal pouch-anal anastomosis is performed in many patients with ulcerative colitis, conflicting data exist about its effects on quality of life. We aimed to determine quality of life and to identify risk factors for impaired quality of life in these patients. METHODS: Forty-eight of 82 patients (59%; median follow-up 57 months [range 21-93 months]) after ileal pouch-anal anastomosis for ulcerative colitis were compared to 48 matched healthy controls. Generic, health-, and disease-related, as well as symptom-specific quality of life was analyzed using five well-established quality of life instruments. RESULTS: Although generic quality of life was comparable between groups, health-related quality of life was impaired after ileal pouch-anal anastomosis. While high stool frequency was associated with impaired health-related and disease-specific quality of life, fecal incontinence and history of pouchitis also caused a deterioration of generic and symptom-related quality of life. Seventy-seven percent of patients reported their quality of life to be better compared to the situation before surgery and 88% would undergo ileal pouch-anal anastomosis again. CONCLUSIONS: Overall quality of life after ileal pouch-anal anastomosis is good. However, high stool frequency, fecal incontinence, and pouchitis are associated with impaired quality of life and should be prevented or treated to the best possible extent.

Expression of growth factors during the healing process of alveolar ridge augmentation procedures using autogenous bone grafts in combination with GTR and an anorganic bovine bone substitute: an immunohistochemical study in the sheep.

OBJECTIVES: This study aims to evaluate the expression of various immunohistochemical growth factors and vascularization markers in augmentation on the mandible comparing onlay bone grafts and Guided Bone Regeneration (GBR). MATERIALS AND METHODS: Using a sheep in vivo model, autogenous bone grafts were harvested from the iliac crest. A combination of a resorbable collagen membrane (CM) and a Deproteinized Bovine Bone Material (DBBM) was performed. This modification of the host side was compared with an onlay bone graft control group. Expression of different vascularization markers was compared between these groups. RESULTS: The expression of revascularization markers was significantly higher within the modification of the host side using GBR and DBBM. Regarding different graft regions, a significantly higher expression within the bone graft using GBR and DBBM could be observed in staining on bone morphogenetic protein-2 (BMP-2) (5.75 vs. 3.55), vascular endothelial growth factor (VEGF) (3.08 vs. 1.64), VEGF Receptor 1 (VEGFR-1) and VEGF Receptor 2 (VEGFR-2) (4.88 vs. 2.24 and 5.06 vs. 2.74), and endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) (5.29 vs. 3.28 and 5.22 vs. 3.09; p = 0.000, all others p < 0.05), whereas the control group showed a higher rate of resorption during the surveillance period until euthanasia of sheep after 16 weeks. CONCLUSION: The use of GBR and DBBM in the transplantation process of autogenous bone grafts compared with the therapeutical use of certain growth factors may enhance vascularization and lower atrophy and resorption. CLINICAL RELEVANCE: The use of a combination of GBR and DBBM in augmentation procedures on the mandible shows less resorption than simple onlay bone grafts and seems to be superior in a clinical use.

Therapeutic elastic tape reduces morbidity after wisdom teeth removal--a clinical trial.

OBJECTIVES: Although the extraction of an impacted third molar (3M) is a routine procedure, postoperative morbidities typically include swelling, pain, and trismus. The aim of the present study was to investigate whether the application of kinesiologic tape can improve the postoperative morbidities associated with 3M surgery, thereby improving the postoperative well-being of patients. MATERIALS AND METHODS: Forty patients assigned for prospective 3M removal were randomized into two treatment groups (with/without kinesiologic tape). Facial swelling was quantified using a five-line measurement at six specific time points. Pain scores were assessed using a visual analog scale, and mouth opening range was assessed by means of standard calipers. In addition, all patients were asked to evaluate overall satisfaction and swelling (both groups) and the effect of the tape on movement and comfort (taped group only). RESULTS: The postoperational application of kinesiologic tape reduced significantly all investigated parameters: swelling, pain, and trismus. Furthermore, patients with kinesiologic tape reported a significantly lower morbidity rate. CONCLUSION: The application of kinesiologic tape following a 3M surgery is a simple and economical, yet medically relevant approach. CLINICAL RELEVANCE: Kinesiologic tape offers patients a less traumatic postoperational experience and therefore holds promise to enhance the quality of life of a large cohort of the population.

Diagnostic pitfalls in pediatric orbital entrapment fractures.

Prompt diagnosis and management of orbital entrapment fractures in the pediatric patient have been advocated. This retrospective study analyzed a cohort of orbital entrapment fractures in pediatric patients with regard to diagnostic pitfalls, treatment and outcomes in a Level I trauma center in Germany. Based on medical records and radiological imaging, patients under the age of 18 years who presented with orbital fractures during 2009-2021 were analyzed. Overall, 125 patients presented with orbital fractures, of whom 29 patients (23.2%) had orbital entrapment fractures. The majority of patients presented with monocle hematoma (n = 23), diplopia (n = 20), and/or restricted extraocular eye movement (n = 14). While all patients with orbital entrapment fractures underwent three-dimensional imaging, 10 radiological reports (34.5%) did not include findings on orbital entrapment fractures. All patients underwent surgical exploration in less than 24 h. In 12 patients, clinical symptoms such as diplopia and restricted ocular elevation were documented upon postoperative evaluation before discharge. Considering the significant proportion of orbital entrapment fractures that are not noted on radiological imaging, prompt clinical examination should be initiated in pediatric patients at risk for orbital fractures. Urgent surgical intervention should be recommended in entrapment fractures.

Quantifying bone healing after mandibular displacement in orthognathic surgery.

Impaired bony healing following bilateral sagittal split osteotomy (BSSO) is a major unmet medical need for affected patients, and rare occurrences can hinder the identification of underlying risk factors. We hypothesised that osseous union following BSSO can be quantified using volumetric analysis, and we aimed to identify the risk factors for impaired bone healing. The percentage change in bony volume was measured in orthognathic patients following BSSO using two consecutive postoperative cone-beam computed tomography scans. Patients' characteristics and treatment parameters were documented, and correlation and regression analyses of these variables performed. Thirty-six patients (23 men and 13 women) with a mean (SD) age of 33.28 (11.86) years were included. The gap site (lingual versus buccal) (p < 0.01) had a significant impact on the change in volume. Age (p = 0.06) showed a trend towards significance. Initial width of the osteotomy gap, sex, and indication for surgery did not influence osseous healing. Increased age at surgery and the side of the buccal osteotomy are independent risk factors for impaired osseous healing following BSSO.

Resection status and margin control in intraoperative frozen sectioning analysis of oral squamous cell carcinoma.

PURPOSE: Intraoperative frozen section analysis (IFSA) is a well-established procedure for determining the intraoperative soft tissue resection status in patients with oral squamous cell carcinoma (OSCC). Margin status is a major predictor of the patient´s outcome, histologically free margins of ≥ 5 mm are demanded. This study evaluates the accuracy of IFSA, the impact of margin status and the impact of intraoperative margin revision on disease-free survival (DFS) and overall survival (OS). METHODS: This retrospective study included 213 patients with OSCC. IFSA results were compared with definitive histopathological reports, Kaplan-Meier analysis was performed. Cut-off values were calculated for resection margins considering known risk factors. RESULTS: IFSA showed positive margins in 8 cases (3.8%). Kaplan-Meier analysis revealed no significant differences for OS or DFS if R0-status was achieved by initial resection or immediate re-resection. Final histopathological evaluation revealed false-positive IFSA in 3/8 cases (37.5%) and false-negative IFSA in 1/205 cases (0.5%). Sensitivity was 83.3% and specificity was 98.6%. Analysis of optimal cut-off values showed no general need for larger resection margins in patients with risk factors. Cut-off values were slightly higher for patients with the risk factor alcohol consumption (7 mm for OS and DFS) or pN + ECS- disease (7 mm for DFS). Optimal cut-off values for tumour-margin-distance were around 6 mm. CONCLUSION: IFSA provides a valuable assessment method for intraoperative soft tissue resection margins. Risk factors seemingly do not significantly influence the extent of tumour resection.