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Meisgeier A, Dürrschnabel F, Pienkohs S, Weiser A, Neff A. Cephalometric Screening Assessment for Superior Airway Space Narrowing-Added Value of Three-Dimensional Imaging. J Clin Med 2024; 13:2685. [PMID: 38731214 PMCID: PMC11084779 DOI: 10.3390/jcm13092685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/19/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Assessing the morphology of the superior airway space is a crucial diagnostic step in the treatment planning of patients with obstructive sleep apnea syndrome (OSAS) or prior to orthognathic surgery. The aim of this study is to evaluate the necessary scope of a two-dimensional cephalometric assessment and the necessity of three-dimensional imaging in the identification of superior airway space narrowing (SASN). Methods: The computed tomography studies of 100 non-obese, non-OSAS patients were evaluated and analyzed retrospectively. Multiplanar reconstructions were created and underwent cephalometric evaluation. The three-dimensional superior airway morphology was segmented and measured for the minimal cross-sectional area (Amin) and volume (V0). Patients were grouped according to Amin < 80 mm2 and V0 < 12 cm3. Cephalometric parameters (CPs) were analyzed according to Amin and V0 with an unpaired t-test, Pearson correlation, and ROC-curve analysis. Results: The CPs regarding sagittal airway space dimensions (IPAS, MPAS, SPAS) and mandibular body length (GoGn) show the strongest correlation to the three-dimensional minimal cross-sectional area (Amin). The ROC-curve analysis classifying for SASN led to an AUC of 0.86 for IPAS, 0.87 for MPAS, 0.88 for SPAS, and 0.63 for GoGn. Three-dimensional imaging may further improve the diagnostic accuracy in the identification of SASN for IPAS below 13.5 mm, MPAS below 10.2 mm, SPAS below 12.5 mm, and GoGn below 90.2 mm. Conclusions: Two-dimensional cephalometric sagittal airway space diameters and mandibular body length are useful initial screening parameters in the identification of superior airway space narrowing. Nevertheless, as the correlation of two-dimensional cephalometric parameters with three-dimensional upper airway space narrowing is varying and highly dependent on acquisition circumstances, indications for three-dimensional imaging, if possible, in the supine position to evaluate upper airway space morphology should be provided generously, especially in patients with low but normal airway space parameters in two-dimensional cephalometry.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Florian Dürrschnabel
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Annabell Weiser
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
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Terletskyi R, Dowgierd K, Chepurnyi Y, Kopchak A, Neff A. Influence of preoperative anatomy and functional status on outcomes after total temporomandibular joint replacement with patient-specific endoprostheses: A retrospective cohort study. Dent Med Probl 2024:0-0. [PMID: 38657189 DOI: 10.17219/dmp/174598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/28/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) replacement may be indicated for various pathological conditions, and the type of condition can affect the surgical procedure and outcomes. The causes of limited range of motion after alloplastic TMJ replacement have not been extensively studied. OBJECTIVES The present study aimed to evaluate the impact of preoperative jaw anatomy and functional status on the immediate and long-term outcomes of total TMJ replacement using a two-component patient-specific TMJ endoprosthesis. MATERIAL AND METHODS This retrospective study included 31 patients who underwent total TMJ replacement surgery between 2016 and 2020. The main outcome variable was the maximal incisal opening (MIO) after treatment. Secondary outcome variables included MIO improvement and the presence and type of postoperative complications. The primary predictive variable was the preoperative initial MIO. Secondary predictive variables included sex, age, indications for TMJ replacement, preoperative occlusion, condition of the glenoid fossa and/or condyle, shortening of the mandibular ramus, sagittal mandible position, lateral chin deviation, shape of the coronoid process, and type of surgery. RESULTS The mean preoperative MIO was 13.0 ±8.0 mm, while the mean MIO 1 month after surgery was 20.6 ±5.5 mm, which was not statistically significant. However, at a later follow-up, functional parameters showed a significant improvement (p = 0.003), with a mean MIO of 32.5 ±5.0 mm 3 years after surgery. Statistical analysis indicated that the initial mouth opening is the strongest predictor of long-term functional recovery after TMJ replacement. Postoperative complications occurred in 4 cases (12.9%) following patient-specific endoprosthesis (PSE) placement. CONCLUSIONS The use of PSEs for TMJ replacement has enabled the restoration of anatomical relationships in complex clinical cases and an improvement in mouth opening. The preoperative MIO was the only factor that significantly influenced long-term functional outcomes.
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Affiliation(s)
- Rostyslav Terletskyi
- Department of Maxillofacial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kyiv, Ukraine
| | - Krzysztof Dowgierd
- Head and Neck Surgery Clinic for Children and Youth, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Poland
| | - Yurii Chepurnyi
- Department of Maxillofacial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kyiv, Ukraine
| | - Andrii Kopchak
- Department of Maxillofacial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kyiv, Ukraine
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, University Hospital of Giessen and Marburg (UKGM), Philipps University of Marburg, Germany
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Meisgeier A, Pienkohs S, Dürrschnabel F, Neff A, Halling F. Rising incidence of severe maxillofacial space infections in Germany. Clin Oral Investig 2024; 28:264. [PMID: 38644434 PMCID: PMC11033243 DOI: 10.1007/s00784-024-05663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Severe maxillofacial space infection (MSI) as an end stage of dentoalveolar diseases or complication of sialadenitis is a potentially life-threatening disease accompanied by complications including airway obstruction, jugular vein thrombosis, descending mediastinitis, sepsis and acute respiratory distress syndrome. The aim of this study was to analyze the incidence and time trends of severe MSI and potentially influencing factors in the German healthcare system over time. MATERIALS AND METHODS Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. A retrospective analysis of incidence and time trends of MSI-associated procedures classified with the Operation and Procedure Classification System (OPS), were statistically evaluated using Poisson regression analysis between 2005 and 2022 and were associated with different epidemiological factors. RESULTS The total standardized incidence rate of MSI-associated procedures in the observational period 2005-2022 was 9.8 (♀8.2; ♂11.4) per 100,000 person years. For all age groups a significant increase of 46.1% in severe MSI - related surgical interventions was registered within the observational period. The largest increase (120.5%) was found in elderly patients over 80 years. There were significant differences of the incidences of MSI-associated surgeries between the different federal states in Germany. CONCLUSIONS Severe MSI are a growing challenge in German health care especially among elderly patients over 80 years. CLINICAL RELEVANCE Severe MSI is a promising target for prevention. There should be more focus in primary dental and medical care especially in groups depending on social support.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany.
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Florian Dürrschnabel
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Frank Halling
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
- Gesundheitszentrum Fulda, Praxis für MKG-Chirurgie, Gerloser Weg 23a, D-36039, Fulda, Germany
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Meisgeier A, Pienkohs S, Moosdorf L, Neff A. Impact of the COVID-19 pandemic on maxillofacial trauma surgery in Germany - implications from the national DRG database. Oral Maxillofac Surg 2024:10.1007/s10006-024-01248-9. [PMID: 38600413 DOI: 10.1007/s10006-024-01248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The COVID-19 pandemic has affected the personal and social lives of millions of people and also impacted the etiological factors of midfacial trauma such as falls, interpersonal violence or traffic accidents. The aim of this study was to analyze the influence of the COVID-19 pandemic on maxillofacial trauma surgery in the German healthcare system. METHODS Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system used in all German hospitals was received from the German Federal Statistical Office. Various trauma-associated procedures of the Operation and Procedure Classification System (OPS), a German modification of the International Classification of Medical Procedures (ICPM), were statistically associated with different epidemiological factors between 2012 and 2021. RESULTS A statistically significant decrease (p < 0.05) in surgeries regarding maxillofacial fractures was registered during the years 2020 and 2021. Young male patients had the largest decline in maxillofacial trauma surgeries during this period (p < 0.05). In contrast. elderly patients 80 years and older showed a dramatic increase in the frequency of fractures in both the midface and the mandible (p < 0.05). CONCLUSIONS During the COVID 19 pandemic there has been a shift in the number, composition and etiology of maxillofacial fracture surgeries. Measures of social distancing and personal risk avoidance had a societal positive effect on the frequency of facial injuries. This stands in contrast to the drastic increase in fractures of elderly people who should be protected primarily by the measures taken. These results can help to understand these influences better in future pandemics. TRIAL REGISTRATION German Clinical Trials Register No: DRKS00032778.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany.
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany
| | - Laura Moosdorf
- Center for Orthopaedics and Trauma Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany
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Stuck BA, Neff A. Leserbrief zu „Das kutane Plattenepithelkarzinom der Haut – ein Update“ [Burda B, Schultz ES. Laryngo-Rhino-Otologie 2023; 102(10): 735–741]. Laryngorhinootologie 2024; 103:91-92. [PMID: 38320565 DOI: 10.1055/a-2211-4095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- B A Stuck
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Marburg, Philipps-Universität Marburg
| | - A Neff
- Klinik für Mund-, Kiefer- und plastische Gesichtschirurgie, Oralchirurgie und Implantologie, Universitätsklinikum Marburg, Philipps-Universität Marburg
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Meisgeier A, Heymann P, Ziebart T, Braun A, Neff A. Wound healing after therapy of oral potentially malignant disorders with a 445-nm semiconductor laser: a randomized clinical trial. Clin Oral Investig 2023; 28:26. [PMID: 38147181 PMCID: PMC10751250 DOI: 10.1007/s00784-023-05438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/18/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES Oral potentially malignant disorders (OPMDs) are the most clinically relevant precursor lesions of the oral squamous cell carcinoma (OSCC). OSCC is one of the 15 most common cancers worldwide. OSCC is with its high rate of mortality an important cause of death worldwide. The diagnosis and therapy of clinically relevant precursor lesions of the OSCC is one of the main parts of prevention of this malignant disease. Targeted therapy is one of the main challenges concerning an oncologically safe tissue removal without overwhelming functional and aesthetic impairment. MATERIALS AND METHODS In this randomized controlled trial, a newly introduced intraoral 445-nm semiconductor laser (2W; cw-mode; SIROLaser Blue, Dentsply Sirona, Bensheim, Germany) was used in the therapy of OPMDs. Duration and course of wound healing, pain, and scar tissue formation were compared to classical cold blade removal with primary suture by measuring remaining wound area, tissue colorimetry, and visual analogue scale. The study includes 40 patients randomized using a random spreadsheet sequence in two groups (n1 = 20; n2 = 20). RESULTS This comparative analysis revealed a significantly reduced remaining wound area after 1, 2, and 4 weeks in the laser group compared to the cold blade group (p < 0.05). In the laser group, a significantly reduced postoperative pain after 1 week was measured (p < 0.05). CONCLUSION Laser coagulation of OPMDs with the investigated 445-nm semiconductor laser is a safe, gentle, and predictable surgical procedure with beneficial wound healing and reduced postoperative discomfort. CLINICAL RELEVANCE Compared to the more invasive and bloody cold blade removal with scalpel, the 445-nm semiconductor laser could be a new functional less traumatic tool in the therapy of OPMDs. The method should be further investigated with regard to the identification of further possible indications. TRAIL REGISTRATION German Clinical Trials Register No: DRKS00032626.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Giessen/Marburg, Germany.
- Faculty of Medicine, Philipps-University, Marburg, 35043, Marburg, Germany.
| | - Paul Heymann
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Giessen/Marburg, Germany
- Faculty of Medicine, Philipps-University, Marburg, 35043, Marburg, Germany
| | - Thomas Ziebart
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Giessen/Marburg, Germany
- Faculty of Medicine, Philipps-University, Marburg, 35043, Marburg, Germany
| | - Andreas Braun
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH University Aachen, Aachen, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Giessen/Marburg, Germany
- Faculty of Medicine, Philipps-University, Marburg, 35043, Marburg, Germany
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Pienkohs SP, Meisgeier A, Herrmann J, Graf L, Reichert CS, Trento G, Neff A. Factors Affecting the Duration of Surgery in the Management of Condylar Head Fractures. J Clin Med 2023; 12:7172. [PMID: 38002784 PMCID: PMC10672676 DOI: 10.3390/jcm12227172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
Prolonged operation times should be avoided due to the associated complications and negative effects on the efficiency of the use of operating room resources. Surgical treatment of mandibular condylar head fractures is a well-established routine procedure at our department, nevertheless, we recognized fluctuating operating times. This study aims to pinpoint the influencing factors, in particular the hypothesis whether the efficiency of intraoperative muscle relaxation may decisively affect the duration of surgery. It analyses 168 mandibular condylar head fractures that were surgically treated in the period from 2007 to 2022 regarding the duration of the surgery and potential factors affecting it. The potential predictors' influence on the dependent variable operation time was mainly calculated as a bivariate analysis or linear regression. Efficiency of relaxation (p ≤ 0.001), fragmentation type (p = 0.031), and fracture age (p = 0.003) could be identified as decisive factors affecting the duration of surgery, as the first surgeon was a constant. In conclusion, surgical intervention should start as soon as possible after a traumatic incident. In addition, a dosage regimen to optimize the efficiency of relaxation should be established in future studies. Fragmentation type and concomitant fractures should also be considered for a more accurate estimation of the operating time.
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Affiliation(s)
- Simon Patrik Pienkohs
- Department of Oral and Maxillofacial Surgery, University of Marburg, D-35043 Marburg, Germany
| | - Axel Meisgeier
- Department of Oral and Maxillofacial Surgery, University of Marburg, D-35043 Marburg, Germany
| | | | - Leontine Graf
- Department of Oral and Maxillofacial Surgery, University of Marburg, D-35043 Marburg, Germany
| | - Clarissa S. Reichert
- Department of Oral and Maxillofacial Surgery, University of Marburg, D-35043 Marburg, Germany
| | - Guilherme Trento
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, D-48149 Münster, Germany
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University of Marburg, D-35043 Marburg, Germany
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Al-Moraissi EA, Neff A, Kaur A, Falci SGM, Maria de Souza G, Ellis E. Treatment for Adult Mandibular Condylar Process Fractures: A Network Meta-Analysis of Randomized Clinical Trials. J Oral Maxillofac Surg 2023; 81:1252-1269. [PMID: 37423262 DOI: 10.1016/j.joms.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Using network meta-analyses (NMA) has become increasingly valuable as it enables the comparison of interventions that have not been directly compared in a clinical trial. To date, there has not been a NMA of randomized clinical trials (RCT) that compares all types of treatments for mandibular condylar process fractures (MCPFs). The aim of this NMA was to compare and rank all the available methods used in the treatment of MCPFs. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted in 3 major databases up to January 2023 to retrieve RCTs that compared various closed and open treatment methods for MCPFs. The predictor variable is treatment techniques: arch bars (ABs) + wire maxillomandibular fixation (MMF), rigid MMF with intermaxillary fixation screws, AB + functional therapy with elastic guidance (AB functional treatment), AB rigid MMF/functional treatment, single miniplate, double miniplate, lambda miniplate, rhomboid plate, and trapezoidal miniplate. Postoperative complications were the outcome variables and included occlusion, mobility, and pain, among other things. Risk ratio (RR) and standardized mean difference were calculated. Version 2 of the Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development, and Evaluations system were used to determine the certainty of the results. RESULTS The NMA included a total of 10,259 patients from 29 RCTs. At ≤6 months, the NMA revealed that the use of 2-miniplates significantly reduced malocclusion compared to rigid MMF (RR = 2.93; confidence interval [CI]: 1.79 to 4.81; very low quality) and functional treatment (RR = 2.36; CI: 1.07 to 5.23; low quality).Further, at ≥6 months, 2-miniplates resulted in significantly lower malocclusion compared to rigid MMF with functional treatment (RR = 3.67; CI: 1.93 to 6.99; very low quality).Trapezoidal plate and AB functional treatment were ranked as the best options in 3-dimensional (3D) plates and closed groups, respectively.3D-miniplates (very low-quality evidence) were ranked as the most effective treatment for reducing postoperative malocclusion and improving mandibular functions after MCPFs, followed closely by double miniplates (moderate quality evidence). CONCLUSIONS This NMA found no substantial difference in functional outcomes between using 2-miniplates versus 3D-miniplates to treat MCPFs (low evidence).However, 2-miniplates led to better outcomes than closed treatment (moderate evidence).Additionally, 3D-miniplates produced better outcomes for lateral excursions, protrusive movements, and occlusion than closed treatment at ≤6 months (very low evidence).
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Thamar University, Yemen.
| | - Andreas Neff
- Professor, Chairman and Medical Director, Department of Oral and Craniomaxillofacial Plastic Surgery, Oral Surgery and Implantology, University Hospital Marburg, Marburg, Hesse, Germany
| | - Amanjot Kaur
- Assistant Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu and Kashmir, India
| | - Saulo Gabriel Moreira Falci
- Adujunct Professor, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, Minas Gerais, Brazil
| | - Glaciele Maria de Souza
- Adujunct Professor, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, Minas Gerais, Brazil
| | - Edward Ellis
- Professor and Chair, Department of Oral and Maxillofacial Surgery University of Texas Health Science Center at San Antonio
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Riechmann M, Schmidt C, Ahlers MO, Feurer I, Kleinheinz J, Kolk A, Pautke C, Schön A, Teschke M, Toferer A, Lux CJ, Kirschneck C, Krombach GA, Ottl P, Vieth U, Stengel J, Völker C, Neff A. Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project. J Clin Med 2023; 12:4946. [PMID: 37568349 PMCID: PMC10419428 DOI: 10.3390/jcm12154946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly controversial. Therefore, the aim of this study is to present an analysis of the consensus- and evidence-based approach to ICR by a German interdisciplinary guideline project of the AWMF (Association of the Scientific Medical Societies in Germany). Following a systematic literature search, including 56 (out of an initial 97) publications, with a predominantly low level of evidence (LoE), two independent working groups (oral and maxillofacial surgery and interdisciplinary, respectively) voted on a draft comprising 25 recommendations in a standardized anonymized and blinded Delphi procedure. While the results of the votes were relatively homogeneous, the interdisciplinary phase required a significantly higher number of rounds (p < 0.001). Most of the controversial recommendations were related to initial imaging (with consensus on CT/CBCT as the current diagnostic standard for imaging), pharmacotherapy (no recommendation due to lack of evidence), discopexy (no recommendation possible due to low LoE) and timing of orthognathic surgery (with consensus on two-staged procedures after invasive TMJ surgery, except for single-stage procedures if combined with total joint reconstruction). Overall, the Delphi procedure resulted in an interdisciplinary guideline offering the best possible evidence- and consensus-based expertise to date in the diagnosis and treatment of ICR.
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Affiliation(s)
- Merle Riechmann
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Gießen and Marburg GmbH, University Hospital Marburg, and Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (M.R.); (C.S.); (J.S.); (C.V.)
| | - Christopher Schmidt
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Gießen and Marburg GmbH, University Hospital Marburg, and Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (M.R.); (C.S.); (J.S.); (C.V.)
- Department for Radiology and Nuclear Medicine, GPR Hospital Rüsselsheim, 65428 Rüsselsheim am Main, Germany
| | - M. Oliver Ahlers
- Medical Practice, CMD-Centrum Hamburg-Eppendorf, 20251 Hamburg, Germany;
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center, Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ima Feurer
- Physiotherapeutic Practice & Orthopedic Manual Therapy, 78315 Radolfzell-Böhringen, Germany;
| | - Johannes Kleinheinz
- Department of Craniomaxillofacial Surgery, University Hospital Münster, Westfälische Wilhelms-University Münster, 48149 Münster, Germany;
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Christoph Pautke
- Medical Practice & Clinic for Oral and Craniomaxillofacial Surgery, 80333 München, Germany;
| | - Andreas Schön
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University, 53127 Bonn, Germany;
| | - Marcus Teschke
- Medical Practice for Oral and Craniomaxillofacial Surgery, 28195 Bremen, Germany;
| | - Astrid Toferer
- Medical Practice for Oral and Craniomaxillofacial Surgery, 8301 Laßnitzhöhe, Austria;
| | - Christopher J. Lux
- Polyclinic for Orthodontics, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Christian Kirschneck
- Polyclinic for Orthodontics, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Gabriele A. Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, 35392 Giessen, Germany;
| | - Peter Ottl
- Department of Prosthodontics and Materials Sciences, Rostock University Medical Center, 18057 Rostock, Germany;
- Department of Life, Light and Matter, University of Rostock, 18059 Rostock, Germany
| | - Ulla Vieth
- Medical Practice for General Medicine, 36088 Hünfeld, Germany;
| | - Johanna Stengel
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Gießen and Marburg GmbH, University Hospital Marburg, and Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (M.R.); (C.S.); (J.S.); (C.V.)
| | - Caroline Völker
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Gießen and Marburg GmbH, University Hospital Marburg, and Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (M.R.); (C.S.); (J.S.); (C.V.)
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Gießen and Marburg GmbH, University Hospital Marburg, and Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (M.R.); (C.S.); (J.S.); (C.V.)
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Otto M, Neff A, Ziebart T, Halling F. A large animal model of periodontal defects in bisphosphonate-related osteonecrosis of the jaw: a comparison of clinical and radiological findings. J Periodontal Implant Sci 2023; 53:53.e43. [PMID: 37681353 DOI: 10.5051/jpis.2204860243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/04/2023] [Accepted: 05/18/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE The objective of this study was to demonstrate the suitability of cone-beam computed tomography (CBCT) for in vivo research in periodontology, with implications for oral implantology, facial traumatology, and all disciplines involved in treating patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). METHODS Halves of the jaws of 9 Swiss mountain sheep, assigned to a control group (n=3), an osteoporosis group (n=3) and a zoledronate-exposed group (n=3), were examined. Clinical and radiological evaluations were conducted using CBCT imaging to assess whether periodontitis and bone defects were observed to a significant extent after surgical tooth extraction. RESULTS In contrast to the control and osteoporosis groups, the zoledronate group exhibited significant residual bone defects following tooth extraction (P<0.05). CBCT more objectively revealed these effects and enabled a numerical evaluation (in mm3). CONCLUSIONS Evaluating residual defects in bone blocks from sheep using CBCT analysis was found to be as effective as a clinical examination conducted by specialists in oral and maxillofacial surgery. The strong correlation between radiological findings and clinical conditions suggests that CBCT may become increasingly important in the future, particularly in periodontological research related to BRONJ.
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Affiliation(s)
- Marius Otto
- Department of Pediatric Surgery, Pediatric Urology and Pediatric Orthopedics, DRK Children's Hospital Siegen, Siegen, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg, Marburg, Germany.
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg, Marburg, Germany
| | - Thomas Ziebart
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg, Marburg, Germany
| | - Frank Halling
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg, Marburg, Germany
- Private Practice PD Dr. Frank Halling, Gesundheitszentrum Fulda, Fulda, Germany
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Pitak-Arnnop P, Sirintawat N, Tangmanee C, Subbalekha K, Messer-Peti R, Auychai P, Meningaud JP, Neff A. To drain or not to drain following posttraumatic ear reconstruction with Dieffenbach's postauricular flap in patients with antithrombotic therapy. J Stomatol Oral Maxillofac Surg 2023; 124:101402. [PMID: 36717019 DOI: 10.1016/j.jormas.2023.101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE To measure the association between drainage use and postoperative complications (POCs) after posttraumatic ear reconstruction (PTER) with Dieffenbach's postauricular flap (DPF) in patients with antithrombotic therapy (ATT). METHODS This was a retrospective double-cohort study of patients undergoing posttraumatic DRF with vs. without drainage in 4 maxillofacial units during a 7-year interval. The primary predictor variable was drainage use, and the main outcome was POCs (i.e., auricular haematoma and infection). Descriptive, bi- and multivariate statistics were computed with P ≤ 0.05 defined as statistically significant. RESULTS The sample was composed of 365 unilateral PTER patients (14% POCs, 15.6% ATT, 34.5% females) aged 58.1 ± 19.7 years (range, 18-101). Among subjects with ATT, drainage use significantly reduced POCs (OR, 0.5; 95% CI, 0.3 to 0.8; P = 0.009; absolute risk reduction [ASR], 34.04%; NNT, 3), especially when delayed surgery > 5 h after trauma was evident (forward stepwise logistic modelling: OR, 20.6; 95% CI, 2 to 215.9; P = 0.012). Drainage placement under DPF in ATT patients with smoking habit, concomitant diseases (e.g. diabetes mellitus), ear cartilage loss, or wound contamination almost halved POC rates (ASR, 34.5 ± 12.1%; range, 22.1% to 49%). Patient's age, gender, American Society of Anesthesiologists (ASA) class, alcohol misuse, ATT and antibiotic type, and international normalised ratio (INR) before surgery had no meaningful effect on POCs. CONCLUSIONS Drainage should be placed under DPF in patients with ATT, regardless of age, gender, ATT and antibiotic type, and preoperative INR.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn University Business School, Bangkok, Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Robert Messer-Peti
- Department of Urology, Caritas Bad Mergentheim - Academic Teaching Hospital of Julius-Maximilians University of Wurzburg, Bad Mergentheim, Germany
| | - Prim Auychai
- Department of Paediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Kämmerer PW, Tribius S, Cohrs L, Engler G, Ettl T, Freier K, Frerich B, Ghanaati S, Gosau M, Haim D, Hartmann S, Heiland M, Herbst M, Hoefert S, Hoffmann J, Hölzle F, Howaldt HP, Kreutzer K, Leonhardt H, Lutz R, Moergel M, Modabber A, Neff A, Pietzka S, Rau A, Reichert TE, Smeets R, Sproll C, Steller D, Wiltfang J, Wolff KD, Kronfeld K, Al-Nawas B. Adjuvant Radiotherapy in Patients with Squamous Cell Carcinoma of the Oral Cavity or Oropharynx and Solitary Ipsilateral Lymph Node Metastasis (pN1)—A Prospective Multicentric Cohort Study. Cancers (Basel) 2023; 15:cancers15061833. [PMID: 36980719 PMCID: PMC10047283 DOI: 10.3390/cancers15061833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
(1) Background: Evaluation of impact of adjuvant radiation therapy (RT) in patients with oral squamous cell carcinoma of the oral cavity/oropharynx (OSCC) of up to 4 cm (pT1/pT2) and solitary ipsilateral lymph node metastasis (pN1). A non-irradiated group with clinical follow-up was chosen for control, and survival and quality of life (QL) were compared; (2) Methods: This prospective multicentric comprehensive cohort study included patients with resected OSCC (pT1/pT2, pN1, and cM0) who were allocated into adjuvant radiation therapy (RT) or observation. The primary endpoint was overall survival. Secondary endpoints were progression-free survival and QL after surgery; (3) Results: Out of 27 centers, 209 patients were enrolled with a median follow-up of 3.4 years. An amount of 137 patients were in the observation arm, and 72 received adjuvant irradiation. Overall survival did not differ between groups (hazard ratio (HR) 0.98 [0.55–1.73], p = 0.94). There were fewer neck metastases (HR 0.34 [0.15–0.77]; p = 0.01), as well as fewer local recurrences (HR 0.41 [0.19–0.89]; p = 0.02) under adjuvant RT. For QL, irradiated patients showed higher values for the symptom scale pain after 0.5, two, and three years (all p < 0.05). After six months and three years, irradiated patients reported higher symptom burdens (impaired swallowing, speech, as well as teeth-related problems (all p < 0.05)). Patients in the RT group had significantly more problems with mouth opening after six months, one, and two years (p < 0.05); (4) Conclusions: Adjuvant RT in patients with early SCC of the oral cavity and oropharynx does not seem to influence overall survival, but it positively affects progression-free survival. However, irradiated patients report a significantly decreased QL up to three years after therapy compared to the observation group.
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Affiliation(s)
- Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
- Correspondence:
| | - Silke Tribius
- Hermann-Holthusen-Institute for Radiation Oncology, Asklepios Hospital St. Georg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Lena Cohrs
- Department of Oral & Cranio-Maxillofacial Surgery, University Hospital of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Gabriel Engler
- Department of Oral and Craniomaxillofacial Plastic Surgery, University of Giessen and Marburg, UKGM, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Tobias Ettl
- Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Kolja Freier
- Department of Oral and Maxillofacial Surgery, Saarland University Medical Center, Kirrberger Str., 66424 Homburg, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany
| | - Shahram Ghanaati
- Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Marienburgstraße 2, 60528 Frankfurt am Main, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Dominik Haim
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
| | - Stefan Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Manuel Herbst
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Rhabanusstraße 4, 55118 Mainz, Germany
| | - Sebastian Hoefert
- Department of Oral and Maxillofacial Surgery, University Hospital of Tübingen, Osianderstraße 2-8, 72076 Tübingen, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstraße 33, 35392 Gießen, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Glückstraße 11, 91054 Erlangen, Germany
| | - Maximilian Moergel
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, University of Giessen and Marburg, UKGM, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Sebastian Pietzka
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Andrea Rau
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Fleischmannstraße 8, 17489 Greifswald, Germany
| | - Torsten E. Reichert
- Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Christoph Sproll
- Department of Oral and Maxillofacial Surgery, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Daniel Steller
- Department of Oral & Cranio-Maxillofacial Surgery, University Hospital of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Klaus-Dietrich Wolff
- Department of Oro-Maxillofacial Surgery, University Hospital Rechts der Isar, Technical University of Munich, Langerstraße 3, 81675 München, Germany
| | - Kai Kronfeld
- Interdisciplinary Center for Clinical Trials, University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
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Pitak-Arnnop P, Witohendro LK, Tangmanee C, Subbalekha K, Sirintawat N, Neff A, Meningaud JP. Assessing effectiveness of endoscope-assisted medial orbital wall fracture repair vs. no surgery using benefit-risk metrics and literature review. J Stomatol Oral Maxillofac Surg 2023; 124:101267. [PMID: 35988910 DOI: 10.1016/j.jormas.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSES To evaluate clinical usefulness of endoscope-assisted medial orbital wall fracture repair via the retrocaruncular approach (rc-EAMOWFR) vs. no surgery (NS), and to perform a narrative review of relevant literature. METHODS This was a retrospective cohort study enrolling isolated medial orbital wall fracture (IMOWF) eyes presented to two German level 1 trauma centers during a 7-year interval. The predictor variable was treatment type (rc-EAMOWFR vs. NS), and the main outcomes were late enophthalmos (LE) and retrobulbar hemorrhage (RH) assessed at 9-15 posttraumatic months. Descriptive and bivariate statistics were computed at α = 95%. Binary adjustments enabled calculation of number needed to treat (NNT), to harm (NNH), and likelihood to be helped or harmed (LHH) for demonstrating benefit-risk tradeoffs. Moreover, a narrative review was also performed. RESULTS The sample comprised 502 patients (28.3% females; mean age, 46.5±19.2 years) with 541 IMOWF eyes (5.9% NS; 7.2% LE; 1.3% RH). Operated eyes had significantly lower LE events than NS eyes (symptomatic IMOWF: P < .0001; 95% confidence interval [CI], .03 to .16; NNT = 2 [95% CI, 1.1 to 6.1]; asymptomatic IMOWF: P < .0001; 95% CI, .01 to .07; NNT = 2 [95% CI, 1.1 to 1.8]). There were 7 (1.5%) RH events following rc-EAMOWFR (P = .99; 95% CI, .06 to 17.4; NNH = 68 [95% CI, 38.3 to 254.2]). LHH calculations posited that rc-EAMOWFR was 34 times more likely to prevent LE than to cause RH, regardless of fracture symptoms. Our results conformed to those of other 15 studies. CONCLUSIONS The results of this study suggest that all IMOWFs be treated. rc-EAMOWFR performed in every 68 IMOWFs would be at risk of one RH event, but prevent 34 eyes from LE due to untreated fractures. Nearly 72% of untreated IMOWFs develop LE after 9 months.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg 35043, Germany.
| | | | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn University Business School, Bangkok, Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg 35043, Germany
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Esthetic and Maxillofacial Surgery, AP-HP, Faculty of Medicine, Henri Mondor University Hospital, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
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Pitak-Arnnop P, Subbalekha K, Muangchan C, Auychai P, Sirintawat N, Meningaud JP, Neff A. Angiotensin-Converting Enzyme Inhibitor-Induced Non-allergic Perioral Angioedema: A Case-Based Scoping Review. Korean J Fam Med 2023; 44:2-10. [PMID: 34808742 PMCID: PMC9887447 DOI: 10.4082/kjfm.21.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 01/31/2023] Open
Abstract
Patients with angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema (ACEIIA) may visit family physicians. The aim of this article was to describe a case of delayed-onset ACEIIA and to present a concise scoping review. Using a case report and a scoping review study design, we report a case of ACEIIA, with clinically confirmed diagnosis. The symptoms resolved after replacing the offending ACEI with another antihypertensive agent. After excluding other causes of perioral swelling and discontinuation of ACEI, the patient was symptom-free within a few days thereafter. Based on this case presentation, we performed a meta-narrative scoping review including up-todate diagnosis and management of ACEIIA, based on published data in English, French, and German from inception to April 1, 2021. Patients with angioedema of unknown origin should be cautiously examined to rule out oral diseases, including allergy to dental materials and drug-induced angioedema. Clinicopathological aspects and current treatment guidelines for ACEI-associated angioedema are also presented.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany,Corresponding Author: Poramate Pitak-Arnnop https://orcid.org/0000-0002-7427-3461 Tel: +49-6421-58-63239, Fax: +49-6421-68990, E-mail:
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chayawee Muangchan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prim Auychai
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Pitak-Arnnop P, Tangmanee C, Mutirangura W, Apipan B, Auychai P, Meningaud JP, Neff A. What factors predict craniomandibular disorders in severe COVID-19 survivors after prolonged intubation? J Stomatol Oral Maxillofac Surg 2022; 123:e631-e638. [PMID: 35809797 PMCID: PMC9259603 DOI: 10.1016/j.jormas.2022.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 12/19/2022]
Abstract
PURPOSES To estimate and identify predictors of craniomandibular disorders (CMDs) in severe COVID-19 survivors after prolonged intubation ≥ 1 week (SCOVIDS-PI). METHODS This retrospective study enrolled two cohorts of SCOVIDS-PIs with vs. without CMD during a one-year period. The predictor variables were demographic, dental, anesthetic, and laboratory parameters. The main outcome was presence of CMD until six post-PI months (yes/no). Appropriate statistics were computed with α = 95%. RESULTS The sample comprised 176 subjects aged 59.2 ± 17.2 years (range, 27-89; 11.9% with CMDs; 30.1% females). CMDs were significantly associated with (1) bilateral posterior tooth loss (P = 0; number needed to screen [NNS] = 1.6), (2) dentofacial skeletal class II/convex face (P = .01; NNS = 2.2), and (3) peak CRP during intensive care ≥ 40 mg/l (P = .01; NNS = 3.5). With combined predictors, NNS became 2 to 4.3. CONCLUSIONS Three predictors of CMDs in SCOVIDS-PIs: bilateral molar loss, convex face, and CRP ≥ 40 mg/l, indicate CMD screening and/or referral to a CMD specialist, regardless of patients' age, gender, underlying CMDs, or previous dental checkups. Screening ∼2 to 4 "SCOVIDS-PIs with ≥ one predictor" will identify one CMD events/patients during the first six post-PI months.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, Faculty of Medicine, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Philipps-University of Marburg, Marburg, Germany.
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Chulalongkorn University, Bangkok, Thailand
| | - Wantanee Mutirangura
- Department of Occlusion and Accredited Training Center for Dental Occlusion and Orofacial Pain, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Benjamas Apipan
- Division of Anesthesiology, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Prim Auychai
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Esthetic and Maxillofacial Surgery, AP-HP, Faculty of Medicine, Henri Mondor University Hospital, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, Faculty of Medicine, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Philipps-University of Marburg, Marburg, Germany,Head of the TMJ Section of the Strasbourg Osteosynthesis Research Group (S.O.R.G), Past President of the European Society of TMJ Surgeons (ESTMJS), Member of the German Association for Functional Diagnostics and Therapy of the TMJ (DGFDT) and of the German Association for Oral and Maxillofacial Surgeons (DGMKG), Germany
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Pitak-Arnnop P, Tangmanee C, Subbalekha K, Sirintawat N, Urwannachotima N, Auychai P, Messer-Peti R, Meningaud JP, Neff A. Factors associated with complications of submental intubation in 339 patients with facial fractures: A German retrospective cohort study. Journal of Stomatology, Oral and Maxillofacial Surgery 2022; 124:101332. [PMID: 36400390 DOI: 10.1016/j.jormas.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/27/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE For nearly four decades, submental intubation (SI) has been introduced and employed to avoid tracheostomy in facial trauma cases where nasal/oral intubation is infeasible or associated with possible risks. The purposes of this study were to estimate the frequency and to identify variables associated with complications of SI (CSI). METHODS The authors organised a retrospective cohort study and enrolled a group of patients with facial trauma and SI during a seven-year interval at two German level one trauma centres where SI has routinely been used in complex facial trauma cases. The predictor variables included demographic, medical, dental, fracture-related, operative, and postoperative parameters. The outcome variable was CSI. We used descriptive, bivariate, and multivariate analyses at the 0.05 significant level. RESULTS The sample included 339 patients (24.5% females, 9.4% had complications) with an average age of 58.2 ± 12.0 years (range, 17-89). Bivariate analyses revealed nine significant variables. However, forward stepwise multiple logistic regression modelling identified three variables statistically associated with CSI: smoking (OR, 691.8; 95% CI, 75.9 to 6303.9; P < 0.0001; number needed to harm [NNH], 6), moderate to high gingival inflammation (OR, 786.7; 95% CI, 66 to 9378.9; P = 0.002; NNH, 12), and postoperative use of chlorhexidine mouthwash (OR, 0.03; 95% CI, 0.001 to 0.77; P = 0.0003; number needed to treat [NNT], 2). CONCLUSIONS smokers and subjects with gingivitis were more likely to experience CSI. Postoperative chlorhexidine rinsing was the potentially modifiable, albeit low-OR, factor. These findings could help to draw an effective guideline against the CSI.
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Pitak-Arnnop P, Meningaud JP, Neff A. Supramuscular upper blepharoplasty approach to orbital roof and/or lower anterior table frontal sinus fractures: A meta-narrative review. J Stomatol Oral Maxillofac Surg 2022; 123:645-654. [PMID: 35605961 DOI: 10.1016/j.jormas.2022.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND An approach to orbital roof fractures (ORFs) and/or lower anterior table frontal sinus fractures (LATFSFs) is a challenging task. The conventional coronal approach (CCA) appears to suit multiple/complex fractures of the upper face, while periorbital transcutaneous incisions (PTIs), e.g. gull wing, open sky, butterfly, and Lynch incisions, often impair aesthetic outcomes. The aims of this paper were to provide an overview of the supramuscular upper blepharoplasty approach (SUBA) to ORFs/LATFSFs. METHODS Using a meta-narrative review study design, the investigators enrolled published data extracted from PubMed/Medline, Embase, Cochrane Library, and Google Scholar concerning SUBA to ORFs/LATFSFs. Only publications with the highest and most recent level of evidence (LoE) in English, French or German available until 6 May 2022 were included. The LoE were evaluated using the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM)'s classification. RESULTS In total, 70 articles were included; however, most contained low LoE. Under general and local anaesthesia, SUBA to ORFs/LATFSFs can be performed safely and appeared to be superior to its submuscular counterpart in terms of fewer risks of adjacent tissue injuries, and speedy operative time (maximal 5 min. in experienced hands). CONCLUSIONS In contrast to CCA and PTIs, the SUBA is a minimally invasive approach to the ORF/LATFSF with favourable aesthetic outcomes, direct visualisation of the fracture, quick operative time, rare complications, and easy learning.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Esthetic, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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18
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Pitak-Arnnop P, Witohendro LK, Tangmanee C, Bhakdinaronk A, Subbalekha K, Auychai P, Sirintawat N, Meningaud JP, Neff A. Dental Screening Including Panoramic Radiograph for Gorlin-Goltz Syndrome in Patients With Multiple Basal Cell Carcinomas. J Cutan Med Surg 2022; 26:586-592. [PMID: 36205130 DOI: 10.1177/12034754221128798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To answer the following clinical research question: "Among patients with multiple basal cell carcinomas (mBCCs), can panoramic radiograph (PaR) facilitate the diagnosis of Gorlin-Goltz syndrome (GGS)?" METHODS This retrospective study enrolled mBCCs subjects who presented to a German tertiary care center between 1 January 2015 and 31 December 2021. The primary predictor was presence of syndromic mBCCs, and the main outcomes were jaw cysts and odontogenic keratocysts (OKCs). Descriptive, bi- and multivariate statistics, diagnostic test evaluation, and number needed to screen (NNS) were computed at α = 95%. RESULTS The sample comprised 527 mBCCs patients (36.1% females; 6.8% GGS; 5.5% OKCs; mean age, 74.5 ± 15.8 years [range, 15-102]). There was a significant association between syndromic mBCCs and jaw cysts (P < .0001; NNS = 2 [95% CI, CI, 1.1 to 1.4]). In the adjusted logistic model, PaR identified GGS via radiographic diagnosis of jaw cysts in case of 1) age ≤ 35 years, 2) ≥ 5 BCCs, and 3) ≥ 1 high-risk BCCs. Nearly every jaw cyst identified by PaR was OKCs (P = .01; 95% CI, 3.1 to 3,101.4; NNS = 1.3 [95% CI, .9 to 2]). The post hoc power was 100%. CONCLUSIONS Dental screening with the use of PaR for mBCCs patients, especially those aged ≤35 years, or with ≥5 BCCs, or ≥1 high-risk BCCs, may be helpful in detection and identification of GGS through recognition of OKCs.
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Affiliation(s)
- Poramate Pitak-Arnnop
- 61061 Faculty of Medicine, Philipps-University of Marburg, and Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Marburg, Germany
| | | | - Chatpong Tangmanee
- 67950 Department of Statistics, Chulalongkorn Business School, Chulalongkorn University, Bangkok, Thailand
| | - Anonknart Bhakdinaronk
- 90449 Division of Oral and Maxillofacial Radiology, Department of Oral Diagnosis, Faculty of Dentistry, Naresuan University Phitsanulok, Phitsanulok, Thailand
| | - Keskanya Subbalekha
- 54773 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Prim Auychai
- 54773 Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nattapong Sirintawat
- 67975 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Jean-Paul Meningaud
- 432204 Department of Plastic, Reconstructive, Esthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- 61061 Faculty of Medicine, Philipps-University of Marburg, and Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Marburg, Germany
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Pitak-Arnnop P, Neff A. Coronal rotation-advancement flap for a large posttraumatic forehead defect: A technical note. J Stomatol Oral Maxillofac Surg 2022; 123:e609-e613. [PMID: 34933136 DOI: 10.1016/j.jormas.2021.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Pitak-Arnnop P, Tangmanee C, Meningaud JP, Neff A. Is orbital wall fracture associated with SARS-CoV-2 ocular surface contamination in asymptomatic COVID-19 patients? Int Ophthalmol 2022; 43:1369-1374. [PMID: 36152172 PMCID: PMC9510495 DOI: 10.1007/s10792-022-02535-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022]
Abstract
Objectives To assess the relationship between orbital wall fractures connecting to paranasal sinuses (OWF-PNS) and SARS-CoV-2 ocular surface contamination (SARS-CoV-2-OSC) in asymptomatic COVID-19 patients. Methods This was a prospective case–control study enrolling two asymptomatic COVID-19 patient cohorts with vs. without OWF-PNS in the case–control ratio of 1:4. All subjects were treated in a German level 1 trauma center during a one-year interval. The main predictor variable was the presence of OWF-PNS (case/control); cases with preoperative conjunctival positivity of SARS-CoV-2 were excluded to rule out the possibility of viral dissemination via the lacrimal gland and/or the nasolacrimal system. The main outcome variable was laboratory-confirmed SARS-CoV-2-OSC (yes/no). Descriptive and bivariate statistics were computed with a statistically significant P ≤ 0.05. Results The samples comprised 11 cases and 44 controls (overall: 27.3% females; mean age, 52.7 ± 20.3 years [range, 19–85]). There was a significant association between OWF-PNS and SARS-CoV-2-OSC (P = 0.0001; odds ratio = 20.8; 95% confidence interval = 4.11–105.2; R-squared = 0.38; accuracy = 85.5%), regardless of orbital fracture location (orbital floor vs. medial wall versus both; P = 1.0). Conclusions Asymptomatic COVID-19 patients with OWF-PNS are associated with a considerable and almost 21-fold increase in the risk of SARS-CoV-2-OSC, in comparison with those without facial fracture. This could suggest that OWF-PNS is the viral source, requiring particular attention during manipulation of ocular/orbital tissue to prevent viral transmission.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Faculty of Medicine, Philipps-University of Marburg, and Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital of Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn University Business School, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Faculty of Medicine, Reconstructive, Esthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HPUniversity Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Faculty of Medicine, Philipps-University of Marburg, and Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital of Marburg, Baldingerstraße, 35043, Marburg, Germany
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21
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Pitak-Arnnop P, Sirintawat N, Subbalekha K, Meningaud JP, Auychai P, Tangmanee C, Neff A. Length of hospital stay and complications of mini-facelift versus modified Blair incision for parotid abscess drainage. Eur Oral Res 2022; 56:124-129. [PMID: 36660218 PMCID: PMC9826706 DOI: 10.26650/eor.2022989445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/03/2021] [Accepted: 12/27/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To compare the length of hospital stay (LHS) and complications between minifacelift (MFL) and modified Blair incisions (MBI) for adult patients undergoing parotid abscess drainage (PAD). Materials and methods A retrospective cohort study design was utilized comprising 2 groups of healthy adult patients (American Society of Anesthesiology [ASA] status I-II) who underwent PAD during a 7-year interval. The primary predictor variable was incision type (MFL vs. MBI). The primary outcomes were LHS and adverse complications resulting from the incision type. Other study variables were grouped into demographic, clinical, microbiological, and therapeutic categories. Difference in the cohort characteristics were analyzed using appropriate descriptive and uni- and bivariate statistics. Multivariate logistic regression was used to measure the effect of the incision type had on the LHS and adverse complication rates. Results The sample included 120 subjects (50% females) with a mean age of 41.7±18.3 years. Patients in the MFL group were hospitalized for 8.2±7.7 days, and the other group stayed in the hospital for 10.2±8 days (adjusted odd ratio [OR] 1.19, 95% confidence interval [95% CI] 0.52 to 2.7; p=0.8). In comparison with MBI, MFL did not significantly increase complication risks in term of facial paralysis (adjusted OR 0.93, 95% CI 0.06 to 15.29; p=1.0) and necessity of re-operation (adjusted OR 0.61, 95% CI 0.1 to 3.8; p=0.7). Conclusion Given no different LHS and complication risks, MFL can replace MBI for ASA I-II adult patients undergoing PAD.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University
Hospital of Giessen and Marburg, UKGM GmbH, Campus
Marburg, Faculty of Medicine, Philipps-University of
Marburg Germany ,To whom correspondence should be addressed: Dr.Poramate Pitak-Arnnop Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus
Marburg, Faculty of Medicine, Philipps-University of Marburg Germany
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of
Dentistry, Mahidol University, Bangkok Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of
Dentistry, Chulalongkorn University, Bangkok Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and
Maxillofacial Surgery, Henri Mondor University Hospital,
AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil France
| | - Prim Auychai
- Department of Paediatric Dentistry, Faculty of Dentistry,
Chulalongkorn University, Bangkok Thailand
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School,
Bangkok Thailand
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University
Hospital of Giessen and Marburg, UKGM GmbH, Campus
Marburg, Faculty of Medicine, Philipps-University of
Marburg Germany
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22
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Pitak-Arnnop P, Witohendro LK, Tangmanee C, Subbalekha K, Sirintawat N, Auychai P, Meningaud JP, Neff A. Benefit-risk appraisal of lip-split mandibular "swing" vs. transoral approaches to posterior oral/oropharyngeal carcinomas using number needed to treat, to harm, and likelihood to be helped or harmed. Surg Oncol 2022; 44:101837. [PMID: 35985085 DOI: 10.1016/j.suronc.2022.101837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE s: To evaluate benefit-risk profiles of lip-split mandibular "swing" vs. transoral approaches (LS-MSA; TOA) to the American Joint Committee on Cancer (AJCC) stage I-III posterior oral/oropharyngeal carcinomas (PO/OPC). METHODS Using a retrospective double-cohort study design, we enrolled stage I-III PO/OPC patients treated in two German medical centers during a 4-year interval. The predictor variable was surgical technique (LS-MSA/TOA), and main outcomes were complete resection with R0 margins (CR-R0), 5-year overall survival and recurrence (OS5; R5), and adverse events (AEs). Descriptive and bivariate statistics were computed with α = 95%. Benefit-risk profiles were investigated using number needed to treat (NNT), to harm (NNH), and likelihood to be helped or harmed (LLH). RESULTS At 5-year follow-ups of 202 subjects, LS-MSA caused significantly better CR-R0 (P = 0.001; NNT: 4) and fewer R5 (P = 0.003; NNT: 5), but more risks of wound dehiscence ([WD]; P = 0.01; NNH = 8), and orocutaneous fistula ([OCF]; P = 0.01; NNH: 10). LLH calculations demonstrated that LS-MSA was 2 and 1.6 times more likely to result in CR-R0 and fewer R5 than an incident of WD. There was no significant difference in OS5, postoperative infections (within 30 postoperative days) and AE domains according to the University of Washington Quality of Life questionnaire version 4 (UW-QoLv4) between the surgical approach groups. CONCLUSIONS Compared to TOA, LS-MSA is an efficacious and tolerable intervention for inspecting and eradicating stage I-III PO/OPCs, and reducing recurrences at 5-year follow-ups. Post-LS-MSA WD and OCF require meticulous concerns and more investigations.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | | | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn University Business School, Bangkok, Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Prim Auychai
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Esthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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23
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Al-Moraissi EA, Kaur A, Günther F, Neff A, Christidis N. Can aerosols-generating dental, oral and maxillofacial, and orthopedic surgical procedures lead to disease transmission? An implication on the current COVID-19 pandemic. Front Oral Health 2022; 3:974644. [PMID: 35979536 PMCID: PMC9376374 DOI: 10.3389/froh.2022.974644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 12/01/2022] Open
Abstract
Various dental, maxillofacial, and orthopedic surgical procedures (DMOSP) have been known to produce bioaerosols, that can lead to the transmission of various infectious diseases. Hence, a systematic review (SR) aimed at generating evidence of aerosols generating DMOSP that can result in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), further investigating their infectivity and assessing the role of enhanced personal protective equipment (PPE) an essential to preventing the spreading of SARS-CoV-2 during aerosol-generating procedures (AGPs). This SR was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) guidelines based on a well-designed Population, Intervention, Comparison, Outcomes and Study (PICOS) framework, and various databases were searched to retrieve the studies which assessed potential aerosolization during DMOSP. This SR included 80 studies (59 dental and 21 orthopedic) with 7 SR, 47 humans, 5 cadaveric, 16 experimental, and 5 animal studies that confirmed the generation of small-sized < 5 μm particles in DMOSP. One study confirmed that HIV could be transmitted by aerosolized blood generated by an electric saw and bur. There is sufficient evidence that DMOSP generates an ample amount of bioaerosols, but the infectivity of these bioaerosols to transmit diseases like SARS-CoV-2 generates very weak evidence but still, this should be considered. Confirmation through isolation and culture of viable virus in the clinical environment should be pursued. An evidence provided by the current review was gathered by extrapolation from available experimental and empirical evidence not based on SARS-CoV-2. The results of the present review, therefore, should be interpreted with great caution.
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Dhamar, Yemen
- *Correspondence: Essam Ahmed Al-Moraissi ;
| | - Amanjot Kaur
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Frank Günther
- Medical Microbiology and Hygiene, Marburg University Hospital, Marburg, Germany
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg Universitätsklinikum Giessen und Marburg GmbH, Marburg, Germany
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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24
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Mandic R, Marquardt A, Terhorst P, Ali U, Nowak-Rossmann A, Cai C, Rodepeter FR, Stiewe T, Wezorke B, Wanzel M, Neff A, Stuck BA, Bette M. The importin beta superfamily member RanBP17 exhibits a role in cell proliferation and is associated with improved survival of patients with HPV+ HNSCC. BMC Cancer 2022; 22:785. [PMID: 35850701 PMCID: PMC9290296 DOI: 10.1186/s12885-022-09854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background More than twenty years after its discovery, the role of the importin beta superfamily member Ran GTP-binding protein (RanBP) 17 is still ill defined. Previously, we observed notable RanBP17 RNA expression levels in head and neck squamous cell carcinoma (HNSCC) cell lines with disruptive TP53 mutations. Methods We deployed HNSCC cell lines as well as cell lines from other tumor entities such as HCT116, MDA-MB-231 and H460, which were derived from colon, breast and lung cancers respectively. RNAi was used to evaluate the effect of RanBP17 on cell proliferation. FACS analysis was used for cell sorting according to their respective cell cycle phase and for BrdU assays. Immunocytochemistry was deployed for colocalization studies of RanBP17 with Nucleolin and SC35 (nuclear speckles) domains. TCGA analysis was performed for prognostic assessment and correlation analysis of RanBP17 in HNSCC patients. Results RNAi knockdown of RanBP17, significantly reduced cell proliferation in HNSCC cell lines. This effect was also seen in the HNSCC unrelated cell lines HCT116 and MDA-MB-231. Similarly, inhibiting cell proliferation with cisplatin reduced RanBP17 in keratinocytes but lead to induction in tumor cell lines. A similar observation was made in tumor cell lines after treatment with the EGFR kinase inhibitor AG1478. In addition to previous reports, showing colocalization of RanBP17 with SC35 domains, we observed colocalization of RanBP17 to nuclear bodies that are distinct from nucleoli and SC35 domains. Interestingly, for HPV positive but not HPV negative HNSCC, TCGA data base analysis revealed a strong positive correlation of RanBP17 RNA with patient survival and CDKN2A. Conclusions Our data point to a role of RanBP17 in proliferation of HNSCC and other epithelial cells. Furthermore, RanBP17 could potentially serve as a novel prognostic marker for HNSCC patients. However, we noted a major discrepancy between RanBP17 RNA and protein expression levels with the used antibodies. These observations could be explained by the presence of additional RanBP17 splice isoforms and more so of non-coding circular RanBP17 RNA species. These aspects need to be addressed in more detail by future studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09854-0.
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Affiliation(s)
- Robert Mandic
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Campus Marburg, Philipps-Universität Marburg, 3. BA, +3/08070, Marburg, Germany.
| | - André Marquardt
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany.,Institute of Pathology, University of Würzburg, Würzburg, Germany.,Bavarian Cancer Research Center (BZKF), Würzburg, Germany
| | - Philip Terhorst
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Campus Marburg, Philipps-Universität Marburg, 3. BA, +3/08070, Marburg, Germany
| | - Uzma Ali
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Campus Marburg, Philipps-Universität Marburg, 3. BA, +3/08070, Marburg, Germany.,Institute for Pharmaceutical Technology & Biopharmacy, Philipps-Universität Marburg, Marburg, Germany
| | - Annette Nowak-Rossmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Campus Marburg, Philipps-Universität Marburg, 3. BA, +3/08070, Marburg, Germany.,Department of Molecular Neuroscience, Institute of Anatomy and Cell Biology, Philipps-Universität Marburg, Marburg, Germany
| | - Chengzhong Cai
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Campus Marburg, Philipps-Universität Marburg, 3. BA, +3/08070, Marburg, Germany
| | - Fiona R Rodepeter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Campus Marburg, Philipps-Universität Marburg, 3. BA, +3/08070, Marburg, Germany.,Institute of Pathology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Thorsten Stiewe
- Institute of Molecular Oncology, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Philipps-Universität Marburg, Marburg, Germany
| | - Bernadette Wezorke
- Institute of Molecular Oncology, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Philipps-Universität Marburg, Marburg, Germany
| | - Michael Wanzel
- Institute of Molecular Oncology, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Philipps-Universität Marburg, Marburg, Germany
| | - Andreas Neff
- Department of Oro- and Maxillofacial Surgery, University Hospital Giessen and Marburg, Campus Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Campus Marburg, Philipps-Universität Marburg, 3. BA, +3/08070, Marburg, Germany
| | - Michael Bette
- Department of Molecular Neuroscience, Institute of Anatomy and Cell Biology, Philipps-Universität Marburg, Marburg, Germany
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25
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Lehner U, Zaretsky E, Goeze A, Wermter L, Stuck BA, Birk R, Neff A, Fischer I, Ghanaati S, Sader R, Hey C. [Pre-treatment dysphagia in head-and-neck cancer patients]. HNO 2022; 70:533-539. [PMID: 35122104 PMCID: PMC9242961 DOI: 10.1007/s00106-021-01128-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND The swallowing and nutritional status of head-and-neck cancer patients after oncological therapy have been extensively researched. However, the same topics are seldom scrutinized before the onset of oncological therapy, although they can influence treatment success in the long term. OBJECTIVE This study focusses on a systematic assessment of swallowing function and nutritional status in head-and-neck cancer patients prior to oncological therapy. MATERIALS AND METHODS In 102 patients, penetration/aspiration (PA scale), limitations of oral intake (Functional Oral Intake Scale, FOIS), and the need for further intervention (NFI) were endoscopically assessed to objectively quantify swallowing function. The subjective evaluation of swallowing function was carried out with the gEAT-10 (German EAT-10) questionnaire, nutritional status was assessed by body mass index (BMI). Possible impact factors for swallowing function and BMI were analyzed by univariate and multivariate methods. RESULTS PAS, FOIS, and NFI values were abnormal in ≤ 15% of patients. BMI was more often too high than too low. Objectively assessed swallowing functions depended predominantly on tumor stage and showed moderate correlations with gEAT-10. The latter mostly yielded a "fail" result. The nutritional status depended on the patients' biological sex and NFI. CONCLUSION In the pre-treatment setting, neither dysphagia nor malnutrition were found in most patients. Impaired swallowing was associated with higher tumor stages, malnutrition with female sex and NFI. A systematic pre-treatment assessment of swallowing and nutritional status in head-and-neck cancer patients appears necessary for modern oncological therapy and optimal patient outcome.
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Affiliation(s)
- Uta Lehner
- Abteilung für Phoniatrie und Pädaudiologie, HNO, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Baldingerstr. 1, 35043, Marburg, Deutschland
| | - Eugen Zaretsky
- Abteilung für Phoniatrie und Pädaudiologie, HNO, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Baldingerstr. 1, 35043, Marburg, Deutschland.
| | - Almut Goeze
- Abteilung für Phoniatrie und Pädaudiologie, HNO, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Baldingerstr. 1, 35043, Marburg, Deutschland
| | - Laura Wermter
- Abteilung für Phoniatrie und Pädaudiologie, HNO, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Baldingerstr. 1, 35043, Marburg, Deutschland
| | - Boris A Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Richard Birk
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Andreas Neff
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Ingo Fischer
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Shahram Ghanaati
- Klinik für Mund‑, Kiefer‑, Plastische Gesichtschirurgie, Universitätsklinikum Frankfurt/Main, Goethe-Universität Frankfurt/Main, Frankfurt/Main, Deutschland
| | - Robert Sader
- Klinik für Mund‑, Kiefer‑, Plastische Gesichtschirurgie, Universitätsklinikum Frankfurt/Main, Goethe-Universität Frankfurt/Main, Frankfurt/Main, Deutschland
| | - Christiane Hey
- Abteilung für Phoniatrie und Pädaudiologie, HNO, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Baldingerstr. 1, 35043, Marburg, Deutschland
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Pitak-Arnnop P, Tangmanee C, Meningaud JP, Neff A. Prolonged viral shedding identified from external splints and intranasal packings in immediately cured COVID-19 patients with nasal fractures: A retrospective study. J Stomatol Oral Maxillofac Surg 2022; 123:287-291. [PMID: 35413460 PMCID: PMC8994412 DOI: 10.1016/j.jormas.2022.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Our aim was to measure and compare prolonged viral shedding (PVS) identified from external splints (ES) and intranasal packings (IP) for isolated nasal fracture (INF) repair in immediately cured asymptomatic vs. mildly symptomatic COVID-19 patients (AS-COVID vs. MS-COVID). METHODS We designed a retrospective cohort study and enroled a sample of post-AS-COVID and post-MS-COVID patients, whose INF were treated at a German level 1 trauma centre. The primary predictor variable was COVID severity presurgery (AS-COVD vs. MS-COVID). The main outcome variable was PVS detected in ES/IP. Other study variables were separated into demographic, clinical, and operative. Descriptive, bi- and multivariate statistics were computed, and statistical significance was set at P≤ 0.05. RESULTS The study sample comprised 15 INF patients (53.3% females; 46.7% post-AS-COVID) with a mean age of 42.2 ± 22.7 years (range, 18-85). 13.3% ES and 53.3% IP were contaminated with SARS-CoV-2. However, only IP-contamination between the two cohorts reached statistical significance (P= 0.01; odds ratio, 0.02; 95% confidence interval, 0 to 0.47; Pearson's r= 0.73; post hoc power = 87.4%). Multiple linear regression models refuted the associations between PVS and the other parameters (i.e. age, gender, time to treatment, length of hospital stay, lengths of ES/IP placement). CONCLUSIONS Despite a relative low sample size, our findings suggest PVS via endonasal materials removed from cured COVID-19 patients, especially those healed from MS-COVID. This PVS may trigger re-infection and surgical site infections and/or transmission to other humans, and thereby, requires further investigations.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Pitak-Arnnop P, Messer-Peti R, Tangmanee C, Neff A, Meningaud JP. Prostate cancer awareness among transgender women after gender-affirming surgery. Prostate 2022; 82:1060-1067. [PMID: 35416318 DOI: 10.1002/pros.24355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prostate gland remains unresected during gender-affirming surgery (GAS) for transgender women (TGW), and may develop malignancies in later life. We sought to evaluate prostate cancer awareness (PCA) among post-GAS TGW. METHODS The investigators implemented a cross-sectional study and enrolled a sample of Thai post-GAS TGW without medical background. Predictor variables were categorized as demographic, clinical, operative, or postoperative. The outcome variable was PCA (yes/no). Appropriate statistics were computed, and a p-value ≤ 0.05 was considered statistically significant. RESULTS The sample consisted of 100 Thai post-GAS TGW (4% bisexual, 12% bachelor [or higher] graduates, 51% service workers, 64% had monthly net income <40,000 TB [or ca. 1050 Euro], 92% operated by plastic surgeons) with a mean age of 26.2 ± 5.4 years (range: 18-45). On bivariate analysis, PCA was significantly associated with educational level (p = 0.007; adjusted odd ratio [ORadj. ]: 5.85; 95% confidence interval [95% CI]: 1.65-20.69), being operated ≥ 10 years (p = 0.01; ORadj. : 0.16; 95% CI: 0.04-0.76), self-recognition of the remaining prostate gland (p = 0.0001; ORadj. : 0.02; 95% CI: 0-0.12), and emphasis on PCA by the GAS operator (p = 0.01; ORadj. : 0.07; 95% CI: 0.01-0.63). Multiple linear regression analysis revealed a statistically significant, positive correlation (r = 0.78; p = 0.0001) among these four predictors, and continued to confirm the positive effect on PCA in TGW with high education and realization of the prostate gland (r = 0.56; p = 0.04) or information on PCA by the operator (r = 0.68; p = 0.003). CONCLUSION The GSA operator should intensively inform TGW about the remnant prostate and the risk of PC, especially those with low and middle levels of education attained.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Robert Messer-Peti
- Department of Urology, Caritas Hospital Bad Mergentheim and Tauberfranken Prostate Centre - Academic Teaching Hospital of Julius-Maximilians-University of Würzburg, Bad Mergentheim, Germany
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
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Lehner U, Zaretsky E, Goeze A, Wermter L, Birk R, Neff A, Fisher I, Ghanaati S, Daffner A, Sader R, Hey C. [Nutritional Risk Screening in head-and-neck cancer patients prior to oncological therapy]. Laryngorhinootologie 2022; 101:652-659. [PMID: 35500596 DOI: 10.1055/a-1823-1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Head-and-neck cancer patients run a high risk of peri- or post-treatment malnutrition that can severely affect the therapy outcome. However, little is known about malnutrition under the pre-treatment condition. Therefore, this study aimed to provide a systematic description of the pre-treatment nutritional status and risk of malnutrition in this population. MATERIAL AND METHODS Before the onset of the oncological therapy, nutritional status of 102 head-and-neck cancer patients was assessed by body mass index (BMI), their risk of malnutrition by "Nutritional Risk Screening" (NRS). Tumour stage and site, patients' age and sex as well as oropharyngeal dysphagia were analysed as possible influence factors. The latter was quantified by the Flexible Endoscopic Evaluation of Swallowing (FEES). RESULTS According to BMI, malnutrition (undernutrition) was found in 6% of patients, a risk of malnutrition (NRS) in 27% of patients, and oropharyngeal dysphagia in 15%. In a linear regression, only oropharyngeal dysphagia was identified as a significant influence factor for the risk of malnutrition (β = 0.380/3.776; p < .001). CONCLUSIONS Pre-treatment risk of malnutrition was found in a quarter of head-and-neck cancer patients. For the early identification of this risk and for the introduction of measures that would help to avoid it, a pre-treatment examination of swallowing functions and a systematic malnutrition screening by means of NRS are recommended.
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Affiliation(s)
- Uta Lehner
- Abt. für Phoniatrie und Pädaudiologie, KHNO, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Eugen Zaretsky
- Abt. für Phoniatrie und Pädaudiologie, KHNO, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Almut Goeze
- Abt. für Phoniatrie und Pädaudiologie, KHNO, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Laura Wermter
- Abt. für Phoniatrie und Pädaudiologie, KHNO, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Richard Birk
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Andreas Neff
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Ingo Fisher
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Shahram Ghanaati
- Klinik für Mund-, Kiefer-, Plastische Gesichtschirurgie, Universitätsklinikum Frankfurt/Main, Goethe-Universität Frankfurt/Main, Frankfurt am Main, Germany
| | - Anna Daffner
- Klinik für Mund-, Kiefer-, Plastische Gesichtschirurgie, Universitätsklinikum Frankfurt/Main, Goethe-Universität Frankfurt/Main, Frankfurt am Main, Germany
| | - Robert Sader
- Klinik für Mund-, Kiefer-, Plastische Gesichtschirurgie, Universitätsklinikum Frankfurt/Main, Goethe-Universität Frankfurt/Main, Frankfurt am Main, Germany
| | - Christiane Hey
- Abt. für Phoniatrie und Pädaudiologie, KHNO, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Germany
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Affiliation(s)
- Poramate Pitak-Arnnop
- Attending, Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - Wantanee Mutirangura
- Associate Professor, Department of Occlusion and Accredited Training Center for Dental Occlusion and Orofacial Pain, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Andreas Neff
- Head Professor and Chairman, Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany; Specialist for Functional Diagnostics and Therapy of the TMJ (DGFDT), Head of the TMJ Section of the Strasbourg Osteosynthesis Research Group (S.O.R.G), Guideline Coordinator of TMJ Surgery of the German Association for Oral-Maxillofacial Surgeons (DGMKG), Immediate Past President of the European Society of TMJ Surgeons (ESTMJS)
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Pitak-Arnnop P, Tangmanee C, Muangchan C, Meningaud JP, Neff A. Asymptomatic or mildly symptomatic COVID-19 patients with craniomaxillofacial injuries have an increase risk of surgical site infection. Br J Oral Maxillofac Surg 2022; 60:1118-1124. [PMID: 35927146 PMCID: PMC9155182 DOI: 10.1016/j.bjoms.2022.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/19/2022] [Accepted: 05/17/2022] [Indexed: 02/09/2023]
Abstract
The aim of this paper was to evaluate the association between ‘asymptomatic or mildly symptomatic’ severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (AS/MS-COVID) and surgical site infection (SSI) after repair of craniomaxillofacial injury (CMFI). Using a case-control study design with a match ratio of 1:4, we enrolled a cohort of AS/MS-COVID cases with immediately treated CMFI during a one-year period. The main predictor variable was SARS-CoV-2 infection (yes/no), and the outcome of interest was SSI (yes/no). The other variables were demographic, clinical, and operative. Appropriate statistics were computed, and p<0.05 was considered statistically significant. The study group comprised 257 cases (28.8% female; 13.2% aged ≥ 60 years; 10.5% with fractures; 39.7% with involvement of nasal/oral/orbital tissue [viral reservoir organs, VROs]; 81.3% with blunt trauma; 19.1% developed an SSI [vs 6.8% in the control group]) with a mean (SD) age of 39.8 (16.6) years (range 19–87). There was a significant relation between SARS-CoV-2 infection and SSI events (p<0.0001; odds ratio 3.22; 95% confidence interval 2.17 to 4.78). On subgroup analysis, SSIs significantly increased with age ≥ 60 years, presence and treatment of fracture, contact with VROs, and prolonged antibiotic use (PAU). However, multivariate logistic regression analysis confirmed a positive effect only from old age, contact with VROs, and PAU (relative risk = 1.56, 2.52, and 2.03, respectively; r = 0.49; p = 0.0001). There was a significant 2.8-fold increase in SSIs among AS/MS-COVID cases, especially in those aged ≥ 60 years, or those with injuries to VROs, or both, who therefore required PAU.
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Schmidt C, Reich R, Koos B, Ertel T, Ahlers MO, Arbogast M, Feurer I, Habermann-Krebs M, Hilgenfeld T, Hirsch C, Hügle B, von Kalle T, Kleinheinz J, Kolk A, Ottl P, Pautke C, Riechmann M, Schön A, Skroch L, Teschke M, Wuest W, Neff A. Controversial Aspects of Diagnostics and Therapy of Arthritis of the Temporomandibular Joint in Rheumatoid and Juvenile Idiopathic Arthritis-An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project. J Clin Med 2022; 11:jcm11071761. [PMID: 35407368 PMCID: PMC8999183 DOI: 10.3390/jcm11071761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction: Due to potentially severe sequelae (impaired growth, condylar resorption, and ankylosis) early diagnosis of chronic rheumatic arthritis of the temporomandibular joint (TMJ) and timely onset of therapy are essential. Aim: Owing to very limited evidence the aim of the study was to identify and discuss controversial topics in the guideline development to promote further focused research. Methods: Through a systematic literature search, 394 out of 3771 publications were included in a German interdisciplinary guideline draft. Two workgroups (1: oral and maxillofacial surgery, 2: interdisciplinary) voted on 77 recommendations/statements, in 2 independent anonymized and blinded consensus phases (Delphi process). Results: The voting results were relatively homogenous, except for a greater proportion of abstentions amongst the interdisciplinary group (p < 0.001). Eighty-four percent of recommendations/statements were approved in the first round, 89% with strong consensus. Fourteen recommendations/statements (18.2%) required a prolonged consensus phase and further discussion. Discussion: Contrast-enhanced MRI was confirmed as the method of choice for the diagnosis of TMJ arthritis. Intraarticular corticosteroid injection is to be limited to therapy-refractory cases and single injection only. In adults, alloplastic joint replacement is preferable to autologous replacement. In children/adolescents, autologous reconstruction may be performed lacking viable alternatives. Alloplastic options are currently still considered experimental.
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Affiliation(s)
- Christopher Schmidt
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (C.S.); (T.E.); (M.R.); (L.S.)
| | - Rudolf Reich
- Practice for Oral and Maxillofacial Plastic Surgery MVZ R(h)einZahn, 53111 Bonn, Germany;
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tübingen, Eberhard Karls University Tübingen, 72074 Tübingen, Germany;
| | - Taila Ertel
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (C.S.); (T.E.); (M.R.); (L.S.)
- Medical Clinic, Hospital of Winsen, 21423 Winsen (Luhe), Germany
| | - Marcus Oliver Ahlers
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Hospital Hamburg-Eppendorf, University of Hamburg, 20146 Hamburg, Germany;
- CMD-Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Martin Arbogast
- Department of Rheumatic Orthopedics and Hand Surgery, Hospital Oberammergau, 82487 Oberammergau, Germany;
| | - Ima Feurer
- Physiotherapeutic Practice & Orthopedic Manual Therapy, 78315 Radolfzell-Böhringen, Germany;
| | - Mario Habermann-Krebs
- Deutsche Rheuma-Liga Bundesverband e.V. (German Patients’ Association for Rheumatic Disorders), 53111 Bonn, Germany;
| | - Tim Hilgenfeld
- Department of Neuroradiology, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, 69120 Heidelberg, Germany;
| | - Christian Hirsch
- Clinic of Pediatric Dentistry, University Hospital Leipzig, University of Leipzig, 04103 Leipzig, Germany;
| | - Boris Hügle
- German Centre for Pediatric Rheumatology, Childrens’ Hospital Garmisch-Partenkirchen, 82467 Garmisch-Partenkirchen, Germany;
| | - Thekla von Kalle
- Department of Pediatric Radiology, Olgahospital, Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, 48169 Münster, Germany;
| | - Andreas Kolk
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Innsbruck, Leopold-Franzens-University Innsbruck, 6020 Innsbruck, Austria;
| | - Peter Ottl
- Department of Prosthodontic Dentistry, University Hospital Rostock, University of Rostock, 18057 Rostock, Germany;
| | - Christoph Pautke
- Medical Practice & Clinic for Oral and Maxillofacial Surgery, 80333 Munich, Germany;
| | - Merle Riechmann
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (C.S.); (T.E.); (M.R.); (L.S.)
| | - Andreas Schön
- Medical Practice & Clinic for Oral and Maxillofacial Surgery, 53842 Troisdorf, Germany;
| | - Linda Skroch
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (C.S.); (T.E.); (M.R.); (L.S.)
| | - Marcus Teschke
- Medical Practice for Oral and Craniomaxillofacial Surgery, 61352 Bad Homburg, Germany;
- Children’s Hospital Wilhelmstift, 22149 Hamburg, Germany
| | - Wolfgang Wuest
- Department of Radiology, Hospital Martha Maria Nürnberg, 90491 Nuremberg, Germany;
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (C.S.); (T.E.); (M.R.); (L.S.)
- Correspondence:
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Pitak-Arnnop P, Subbalekha K, Sirintawat N, Meningaud JP, Tangmanee C, Auychai P, Neff A. A retrospective cohort study on predictors associated with skull base invasion of maxillary ameloblastomas. J Stomatol Oral Maxillofac Surg 2022; 123:e439-e447. [PMID: 35318133 DOI: 10.1016/j.jormas.2022.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To identify factors associated with skull base involvement (SBI) of maxillary ameloblastomas (MA). METHODS This retrospective cohort study was composed of MA patients treated during a 7-year period. Demographic, radiographic, and nine immunohistopathologic predictor variables were included. The outcome variable was presence of SBI (yes/no). Descriptive, bi- and multivariate statistics were computed, and P ≤ .05 in multivariate analyses was considered statistically significant. RESULTS The sample comprised 23 subjects (34.8% females; 21.7% with SBI) with a mean age of 50.3 ± 18.2 years. Candidate predictors of an SBI in MAs were 1) male gender, 2) a low Karnofsky Performance Status score (KPS), 3) multilocular radiolucency, 4) ill-defined margins, 5) cortical perforation, 6) inclusion of an unerupted tooth, 7) moderate to strong reactivity to p53, Ki-67, CD10, astrocyte elevated gene-1 (AEG-1) protein, carbonic anhydrase IX (CA IX), calretinin (calbindin2; CALB2), and BRAF-V600E, and 8) negative to low immunopositivity to α-smooth muscle actin (α-SMA) and syndecan-1 (CD138). However, multivariate analyses confirmed the significant associations of SBI with negative/low syndecan-1 reactivity (P = .003; adjusted odds ratio [ORadj.], 4.04; 95% confidence interval [95% CI], -.89 to -.48; Pearson's Correlation Coefficient [r] = -.74) and with KPS (P = .003; ORadj., 4.04; 95% CI, -.78 to -.17; r = -.54) only. CONCLUSIONS Our findings suggest an aggressive approach to MAs with negative to low syndecan-1 immunopositivity and/or in multi-morbid patients (who may have difficulty in access to health care). Otherwise, health care inequalities due to low KPS scores should be minimized or eliminated.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Esthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Prim Auychai
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Pitak-Arnnop P, Meningaud JP, Sirintawat N, Subbalekha K, Auychai P, Iamaroon A, O-Charoenrat P, Suntorntham S, Messer-Peti R, Neff A. A German AWMF's S2e/realist synthesis and meta-narrative snapshot of craniomaxillofacial manifestations in COVID-19 patients: Rapid living update on 1 January 2021. J Stomatol Oral Maxillofac Surg 2022; 123:64-73. [PMID: 33524604 PMCID: PMC9767311 DOI: 10.1016/j.jormas.2021.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/25/2021] [Indexed: 12/24/2022]
Abstract
PURPOSES To execute a review answering the following question: "Among novel coronavirus disease (COVID19) patients, what are craniomaxillofacial (CMF) manifestations?" based on the RAMESES and the German Association of Scientific Medical Societies (AWMF)'s S2e guidelines. METHODS We performed a realist synthesis and meta-narrative review extracting data in English, French, German and Thai from PubMed/Medline, Embase, Biomed Central, Cochrane Library, and Thai Journals Online, until 1 January 2021. The primary outcome variable was CMF manifestations grouped into 5 categories: (1) mouth and throat, (2) nose, paranasal sinus, and skull base (3) ocular/orbital and periorbital tissue, (4) ear, and (5) craniofacial skin. Appropriate statistics was computed. RESULTS Thirty-seven original articles meeting the inclusion criteria were analysed; all were in English and indexed in PubMed/Medline. Hand searches of their references yielded a total of 101 articles for the review. Most data were in low level of evidence and focused on smell and taste disturbances and non-specific orofacial lesions. Iatrogenic complications may occur in this body region. Conservative measures remained effective and were usually enough for patient care. CONCLUSION Because SARS-CoV-2 infection is new and becomes the stringent worldwide pandemic within a short time period, most of the data on CMF symptoms are of low level evidence. Apart from taste and smell dysfunctions, non-specific CMF lesions can be found and treated conservatively. Treatment complications are possible. Dentists and CMF surgeons are privileged to examine the orofacial region and work closely with colleagues in other specialities to combat this pandemic.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany,Corresponding author at: Klinik für MKG-Chirurgie, Universitätsklinikum Marburg, UKGM, Baldingerstr., 35043 Marburg, Germany
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Prim Auychai
- Department of Paediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Anak Iamaroon
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chaing Mai, Thailand,Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Chaing Mai, Thailand
| | | | - Surajit Suntorntham
- HRH Princess Chulabhorn College of Medical Science, Chulaborn Royal Academy, Bangkok, Thailand
| | - Robert Messer-Peti
- Department of Urology, Medius Klinik Ostfildern‐Ruit – Academic Teaching Hospital of University Tübingen, Ostfildern, Germany
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Schmidt C, Ertel T, Arbogast M, Hügle B, Kalle TV, Neff A. Clinical Practice Guideline: The Diagnosis and Treatment of Rheumatoid Arthritis and Juvenile Idiopathic Arthritis of the Temporomandibular Joint. Dtsch Arztebl Int 2022; 119:47-54. [PMID: 34874262 DOI: 10.3238/arztebl.m2021.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Involvement of the temporomandibular joint can be shown in 40-90% of patients with rheumatoid arthritis and juvenile idiopathic arthritis (JIA), although it is often asymptomatic. Restricted jaw mobility and jaw pain can be found in approximately 20% of patients with JIA (prevalence: 70 per 100 000 persons). Early diagnosis and treatment of the underlying disease are essential for a good outcome, but uniform, consensus-based management is still lacking. METHODS The clinical practice guideline is based on the findings of a systematic literature review in multiple databases and a Delphi procedure to obtain consensus on the recommendations. RESULTS Most of the identified studies were retrospective. Patients with JIA should undergo clinical screening with a structured examination protocol once per year in childhood and adolescence, and thereafter as well if the temporomandibular joint is involved. The diagnosis of chronic rheumatoid arthritis of the temporomandibular joint is established with contrastenhanced magnetic resonance imaging. Conservative treatment (antirheumatic basal therapy, local measures) is unsuccessful in less than 10% of patients. In such cases, arthroscopy and arthrocentesis can be used for temporary symptom relief and functional improvement. Intraarticular corticosteroid injections should be given only once, and only in otherwise intractable cases. In severe cases where all other options have been exhausted (<1%), open surgical treatment can be considered, including alloplastic joint replacement. CONCLUSION Oligosymptomatic and asymptomatic cases are common even with radiologic evidence of marked joint damage. The possibility of rheumatic involvement of the temporomandibular joint must be kept in mind so that serious complications can be avoided. Regular clinical evaluation of the temporomandibular joint is recommended, particularly for patients with juvenile idiopathic arthritis.
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Pitak-Arnnop P, Sirintawat N, Tangmanee C, Sukphopetch P, Meningaud JP, Neff A. Inanimate surface contamination of SARS-CoV-2 during midfacial fracture repair in asymptomatic COVID-19 patients. J Stomatol Oral Maxillofac Surg 2022; 123:e233-e240. [PMID: 35063683 PMCID: PMC8767911 DOI: 10.1016/j.jormas.2022.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 12/24/2022]
Abstract
Purposes To evaluate inanimate surface contamination of SARS-CoV-2 during midfacial fracture repair (MFR) and to identify relevant aggregating factors. Methods Using a prospective non-randomised comparative study design, we enrolled a cohort of asymptomatic COVID-19 patients undergoing MFR. The predictor variables were osteofixation system (conventional titanium plates [CTiP] vs. ultrasound-assisted resorbable plates [USaRP]). The main outcomes were the presence of SARS-CoV-2 on four different surfaces. Other study variables were categorised into demographic, anatomical, and operative. Descriptive, bi- and multivariate statistics were computed. Results The sample consisted of 11 patients (27.3% females, 63.6% right side, 72.7% displaced fractures) with a mean age of 52.7 ± 20.1 years (range, 19–85). Viral spread was, on average, 1.9 ± 0.4 m. from the operative field, including most oral and orbital retractors’ tips (81.8% and 72.7%) and no virus was found at 3 m from the operative field, but no significant difference was found between 2 osteofixation types. On binary adjustments, significantly broader contamination was linked to centrolateral MFR (P = 0.034; 95% confidence interval [CI], 0.05 to 1.02), and displaced MFR > 45 min (P = 0.022; 95% CI, 0.1 to 1.03). Conclusions USaRP, albeit presumably heavily aerosol-producing, cause similar SARS-CoV-2 distribution to CTiP. Non-surgical operating room (OR) staff should stay ≥ 3 m from the operative field, if the patient is SARS-CoV-2-positive. Enoral and orbital instruments are a potential virus source, especially during displaced MFR > 45 min and/or centrolateral MFR, emphasising an importance of appropriate patient screening and OR organisation.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, UKGM GmbH, Campus Marburg, Faculty of Medicine, University Hospital of Giessen and Marburg, Philipps-University of Marburg, Baldingerstr, Marburg 35043, Germany.
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Passanesh Sukphopetch
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, AP-HP, Faculty of Medicine, Henri Mondor University Hospital, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, UKGM GmbH, Campus Marburg, Faculty of Medicine, University Hospital of Giessen and Marburg, Philipps-University of Marburg, Baldingerstr, Marburg 35043, Germany
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Wunsch A, Neff A, Meningaud JP, Subbalekha K, Sirintawat N, Pitak-Arnnop P. Bardach's triple-legged rotation flap as single-staged 3D helical upper-third reconstruction: A technical note. Stomatologija 2022; 24:85-88. [PMID: 37140258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Reconstruction of the helical upper-third is often technically demanding, especially when the defect is huge and the ear is severely deformed. The aim of this short communication was to present an alternative technique to rebuild this difficult task, using a modification of the Bardach's three-legged rotation flap for scalp closure. METHODS To achieve the flap design, we raised the retro- and supraauricular tissue with the Dieffenbach's postauricular advancement fl ap. The Gillies' V-Y advancement fl ap helped to develop the preauricular fl ap, and the Mustardé's otoplastik technique was used to reduce the gap between the resected ear cartilage and the temple. CONCLUSION This flap technique appears simple and quick; thereby, it can be used as a single-staged reconstruction alternative in aging patients with multiple comorbidities.
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Affiliation(s)
| | | | | | | | | | - Poramate Pitak-Arnnop
- Klinik für MKG-Chirurgie, Universitätsklinikum Marburg, UKGM, Baldingerstr., 35043 Marburg, Germany.
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Seyedi Moghaddam S, Neff A. Avoidance of milk and dairy products after oral surgery-is such a recommendation still valid? A cross-sectional study among German and international oral and maxillofacial surgeons and dental practitioners with review of the literature. Oral Maxillofac Surg 2021; 26:563-573. [PMID: 34694519 DOI: 10.1007/s10006-021-01017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE For prevention of wound-healing complications, patients in German-speaking countries are traditionally advised to avoid consumption of milk and dairy products after oral surgery. In the absence of national and international guidelines, this study investigates scientific evidence and compares international practice, frequency scale, and rationale behind such recommendation. METHODS Comparison of a German cross-sectional mono-center-questionnaire pilot study and a survey among international oral and maxillofacial surgeons (OMFS), specialized oral surgeons and general dentists, evaluating international practice regarding post-operative dietary and nutrition recommendations. Our literature review further assessed scientific evidence for relevant effects of probiotics, prebiotics, and/or synbiotics. RESULTS Among German study participants, 56% (n = 64/114) advise patients to avoid milk and dairy products, with 42% of OMFS (n = 38) and 65% (n = 76) of the general dentists recommending abstention (p = .027). In striking contrast, such recommendation could not be identified in our international survey (n = 143) (t test, p < .001) nor in the literature. There were significant differences between German and international study participants regarding the rationale for dietary recommendations, with dental schools and literature most frequently indicated as sources (Fisher's exact test, p < .001). CONCLUSION The hypothesis of a harmful effect of the consumption of milk and dairy products after dentoalveolar surgery could not be supported by evidence. The recommendation to avoid dairy products post-surgery was identified as a specific phenomenon practiced almost exclusively in German-speaking countries. Corresponding recommendations, most probably based on a now irrelevant risk of contracting tuberculosis from milk products, can at present no longer be substantiated.
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Affiliation(s)
- Schiwa Seyedi Moghaddam
- Dental Office Dr. Jalali Sohi, 63796, Kahl am Main, Germany. .,Philipps University of Marburg, Biegenstraße 10, 35037, Marburg, Germany.
| | - Andreas Neff
- Klinik and Poliklinik für Mund-, Kiefer- and Gesichtschirurgie (Oral and Maxillofacial Surgery), Universitätsklinikum Marburg, 35033, Marburg, Germany
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Auychai P, Neff A, Pitak-Arnnop P. Tongue-Tie children with a severe Hazelbaker score or difficult breastfeeding greatly benefit from frenotomy or frenuloplasty with/without anaesthesia - First do or do no harm? J Stomatol Oral Maxillofac Surg 2021; 123:e76-e81. [PMID: 34537438 DOI: 10.1016/j.jormas.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022]
Abstract
Tongue-tie (ankyloglossia) is a relatively common congenital anomaly characterised by an abnormally short lingual fraenulum, causing limitation of tongue mobility. There have been immense controversies regarding diagnosis, clinical significance and management of such condition hitherto. Although most tongue-tie babies are asymptomatic without feeding difficulties, operative corrections may be necessary in some cases to improve their breastfeeding. Using a meta-narrative reviewing study design, the aim of this concise review was to demonstrate the current evidences for surgical indications, optimal type and timing, and functional improvement from tongue-tie surgery. We reviewed and discussed the included evidences based on five topics: (1) basic sciences, (2) clinical equipoise, (3) anaesthesia during childhood, (4) evidence-based practice and surgical meta-analyses, and (5) appropriate patient assessment in routine paediatric practice.
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Affiliation(s)
- Prim Auychai
- Department of Paediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM, Campus Marburg, Philipps University of Marburg, Marburg, Germany
| | - Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM, Campus Marburg, Philipps University of Marburg, Marburg, Germany.
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Pitak-Arnnop P, Auychai P, Subbalekha K, Malakul A, Meningaud JP, Neff A. An approach to a repeated self-biting tongue injury in a toddler. Arch Pediatr 2021; 28:576-579. [PMID: 34507865 DOI: 10.1016/j.arcped.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/22/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children with tongue injuries often visit the pediatric emergency department. The vast majority of cases can be conservatively treated, while some injuries require operative repair. The aim of this article was to demonstrate a "back-to-basics" approach to a refractory bifid tongue injury in a toddler. CASE DESCRIPTION A 1-year-old toddler with a tongue injury was unsuccessfully treated three times within a week by a surgeon in another specialty; all reconstructions were mucosal only. The case was then referred to our maxillofacial unit for proper management. On examination, the recurrent injury seemed to occur because of the patient's self-biting habit. We performed the fourth reconstruction of the tongue muscles and mucosa, and because of no dental prosthetic laboratory available in our hospital, we used transparent adhesive drapes fixed by resorbable sutures to cover the patient's anterior teeth instead of bite guards. The toddler was fed via a nasogastric tube for 1 week under 2-day antibiotic prophylaxis and routine oral care. The patient was discharged without any complications 1 week later. CONCLUSIONS AND PRACTICAL IMPLICATIONS The causes of repeated orofacial injuries should be identified and require particular attention to establish a proper treatment. For intraoral injuries in pediatric patients, self-biting habits should not be overlooked. The application of materials in an operating theater can help the treating clinicians improve the treatment outcomes.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps University, Marburg 35043, Germany.
| | - Prim Auychai
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Atinuch Malakul
- Department of Occlusion, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps University, Marburg 35043, Germany
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Pitak-Arnnop P, Subbalekha K, Sirintawat N, Tangmanee C, Auychai P, Muangchan C, Sukphopetch P, Meningaud JP, Neff A. Are oral lichen planus patients at high risk of hepatitis C? A case-control study. J Stomatol Oral Maxillofac Surg 2021; 123:e37-e42. [PMID: 34332181 DOI: 10.1016/j.jormas.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the correlation between oral lichen planus (OLP) and viral hepatitis C (HCV). METHODS This retrospective case-control study included a sample of OLP patients in a 3-year interval. The predictor variable was the presence of OLP (yes/no). The outcome variable was the diagnosis of HCV. Other study variables were grouped into demographic, anatomic, and clinical. Descriptive, bi- and multivariate statistics were computed with a significant level at P ≤ 0.05. RESULTS The sample was composed of 237 OLP patients (38.8% females) with a mean age of 59.9 ± 17.8 years (range, 17-96), and 948 age- and gender-matched control individuals. The significant higher frequency of HCV was identified in OLP patients (frequency: 19.8% vs. 2.1%; adjusted matched odds ratio [mORadj], 9.5; 95% confidence interval [95% CI], 5.98 to 15.91; P < 0.0001; Pearson's Phi coefficient [rphi], 0.307). In the adjusted model, OLP with HCV was associated with 1) oro-cutaneous manifestations (mORadj, 17.58; 95% CI, 1.92 to 161.26; P = 0.0059; Bayesian posterior probability of positive test [Wp], 96%), 2) any intraoral forms other than reticular/plaque-liked forms (mORadj, 0.09; 95% CI, 0.04 to 0.18; P < 0.0001; Wp, 52%), and 3) poor response to topical corticosteroids (mORadj, 0.05; 95% CI, 0.02 to 0.16; P < 0.0001; Wp, 88%). CONCLUSIONS OLP, especially oro-cutaneous disease or steroid-refractory OLP, are associated with an increased frequency of HCV. Not only HCV screening in OLP patients, but oral examination in HCV patients, are both recommended as primary preventive measures.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Prim Auychai
- Department of Paediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chayawee Muangchan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Passanesh Sukphopetch
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Goeze A, Zaretsky E, Lehner U, Wermter L, Mayer M, Stuck BA, Birk R, Neff A, Fisher I, Stöver T, Kramer S, Ghanaati S, Sader R, Hey C. [Post-operative prevalence of dysphagia in head-and-neck cancer patients in the acute care units]. Laryngorhinootologie 2021; 101:320-326. [PMID: 34187052 DOI: 10.1055/a-1528-7584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Dysphagia constitutes a frequent post-operative functional impairment in head-and-neck cancer patients. This impairment can result in aspiration/penetration and limitations of oral intake. Therefore, often it requires a therapeutic intervention. In this study, prevalence of post-operative dysphagia and its associations with the tumour stage, localisation, patients' age, and biological sex were analysed for the inpatient treatment setting. MATERIAL AND METHODS A total of 201 adult head-and-neck cancer patients (mean age 63 years) were analysed prospectively by FEES in two university hospitals in regard to their penetration/aspiration, limitations of oral intake, and need for therapeutic interventions directly after the operative tumour treatment. Additionally, the influence of the same patients' characteristics on these three parameters were analysed by means of univariate and multivariate statistical methods. RESULTS Out of 201 patients, 66.7 % needed a therapeutic intervention because of their dysphagia, 57.2 % needed a nasogastral or PEG tube due to limitations of oral intake, 45.3 % had an aspiration. In the latter subgroup, 38.5 % had a silent aspiration. Higher tumour stage, patients' higher age and male sex were shown to be significant influence factors for dysphagia, tumour localisation showed only a marginally significant result. CONCLUSIONS The study demonstrated a clinical importance and relevance of the consequent and systematic treatment of post-operative dysphagia in head-and-neck cancer patients in the acute care units as a constituent of a modern oncological therapy.
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Affiliation(s)
- Almut Goeze
- Abt. für Phoniatrie und Pädaudiologie, KHNO,Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland
| | - Eugen Zaretsky
- Abt. für Phoniatrie und Pädaudiologie, KHNO,Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland
| | - Uta Lehner
- Abt. für Phoniatrie und Pädaudiologie, KHNO,Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland
| | - Laura Wermter
- Abt. für Phoniatrie und Pädaudiologie, KHNO,Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland
| | - Miriam Mayer
- Abt. für Phoniatrie und Pädaudiologie, KHNO,Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland
| | - Boris A Stuck
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland
| | - Richard Birk
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland
| | - Andreas Neff
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland
| | - Ingo Fisher
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland
| | - Timo Stöver
- Klinik für HNO-Heilkunde, Universitätsklinikum Frankfurt/Main, Goethe-Universität Frankfurt/Main, Frankfurt, Deutschland
| | - Sabine Kramer
- Schwerpunkt für Phoniatrie und Pädaudiologie, Universitätsklinikum Frankfurt/Main, Goethe-Universität Frankfurt/Main, Frankfurt am Main, Deutschland
| | - Shahram Ghanaati
- Klinik für Mund-, Kiefer-, Plastische Gesichtschirurgie, Universitätsklinikum Frankfurt/Main, Goethe-Universität Frankfurt/Main, Frankfurt am Main, Deutschland
| | - Robert Sader
- Klinik für Mund-, Kiefer-, Plastische Gesichtschirurgie, Universitätsklinikum Frankfurt/Main, Goethe-Universität Frankfurt/Main, Frankfurt am Main, Deutschland
| | - Christiane Hey
- Abt. für Phoniatrie und Pädaudiologie, KHNO,Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland
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Jung JP, Haunstein K, Müller HH, Fischer I, Neff A. Intensive Care as an Independent Risk Factor for Infection after Reconstruction and Augmentation with Autologous Bone Grafts in Craniomaxillofacial Surgery: A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10122560. [PMID: 34207893 PMCID: PMC8228131 DOI: 10.3390/jcm10122560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
Autologous bone grafts for reconstruction and augmentation are routinely used for maintaining functionality and facial aesthetics. Associated complications, however, have a significant impact on patients and health care systems. This study aims to investigate the possible risk factors associated with the occurrence of complications in order to provide evidence for the outcome of autologous bone graft reconstructive procedures. Patients from 2008 to 2018 who underwent autologous (mostly mandibular) reconstruction were included in the observational study. Clinical, pathological, and therapeutic factors were examined in univariate and multivariate analysis for significance with occurring complications. A multivariate model was used to create a prognostic model predicting the occurrence of complications. Graft complications requiring revision were exhibited by 33/128 patients. Infections were most frequent, with 4/22 patients affected by multi-resistant germs. Multivariate analysis showed radiotherapy (OR = 5.714; 95% CI: 1.839–17.752; p = 0.003), obstructive pulmonary disease (OPD) (OR = 4.329; 95% CI: 1.040–18.021; p = 0.044) and length of defect (in mm) (OR = 1.016; 95% CI: 1.004–1.028; p = 0.009) as independent risk factors associated with graft complications with high accuracy of prediction (AUC = 0.815). Intensive care (OR = 4.419; 95% CI: 1.576–12.388; p = 0.005) with a coefficient between intensive care and OPD (0.214) being low was identified as the most relevant risk factor for infection. Although intensive care is not a classic risk factor, but rather a summation of factors not reaching significance in the individual case, a stay in ICU (intensive care unit) needs to be considered for graft complications. As a clinical consequence, we recommend using the best possible hygienic measures during procedures e.g., while performing dressing and drainage changes in ICU.
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Affiliation(s)
- Jonas P. Jung
- Department of Oral and Maxillofacial Surgery, University of Marburg, Baldingerstrasse, D-35043 Marburg, Germany; (K.H.); (I.F.); (A.N.)
- Correspondence: ; Tel.: +49-151-282-554-31 or +49-6421-58-63237
| | - Kathrin Haunstein
- Department of Oral and Maxillofacial Surgery, University of Marburg, Baldingerstrasse, D-35043 Marburg, Germany; (K.H.); (I.F.); (A.N.)
| | - Hans-Helge Müller
- Institute of Medical Bioinformatics and Biostatistics, University of Marburg, Bunsenstrasse 3, D-35032 Marburg, Germany;
| | - Ingo Fischer
- Department of Oral and Maxillofacial Surgery, University of Marburg, Baldingerstrasse, D-35043 Marburg, Germany; (K.H.); (I.F.); (A.N.)
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University of Marburg, Baldingerstrasse, D-35043 Marburg, Germany; (K.H.); (I.F.); (A.N.)
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Johner JP, Essig H, Neff A, Wagner MEH, Blumer M, Gander T. Volumetric Evaluated Bone Resorption After Open Reduction and Internal Fixation of Condylar Head Fractures of the Mandible. J Oral Maxillofac Surg 2021; 79:1902-1913. [PMID: 34062130 DOI: 10.1016/j.joms.2021.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Decision making in the management of condylar head fractures remains difficult due to its dependency on multiple factors like fracture type, degree of dislocation, patient`s age and dental condition. As open reduction and internal fixation (ORIF) of condylar head fractures (CHFs) becomes more popular, the question of osteosynthesis removal is controversial. So far, information on volumetric changes after ORIF are available for a short-term period (<6 months) only. This study, therefore, was performed to assess bone resorption after condylar head fractures and to follow-up intermediate-term (>1 year) remodelling after removal of metallic osteosynthesis material. Furthermore clinical outcome was measured using Helkimo Index and put in relation with bone resorption. MATERIALS AND METHODS A retrospective analysis of 19 patients who underwent open reduction and internal fixation of condylar head fractures at the University Hospital of Zürich between January 2016 and April 2018 using intraoperative cone-beam computed tomography repositioning control was conducted. The bone resorption on the condylar head was measured in the course after removal of osteosynthesis material by segmenting and superimposing of the postoperative 3D radiologic follow-up exam (T2) over the initial intraoperative cone-beam computed tomography (T1) using iPlan-CMF software. Complementary Helkimo index was assessed to put resorption rate in relation to clinical outcome. RESULTS A total of 19 patients fulfilled the inclusion criteria. The mean follow-up time was 15.6 months and the mean bone resorption on the condylar head was -0.348cm3 or -15.29% of segmented condylar head. There was no correlation of clinical outcome and bone resorption. CONCLUSIONS Helkimo index showed satisfying results; therefore, ORIF of condylar head fracture proves as a feasible treatment option. The mean bone resorption rate of -15.29% in the intermediate-term follow-up time (mean 15.6 months) is comparable to findings of other studies with short-term follow-up time (< 6 months). Thus, postinterventional remodeling activity and resorption seems highest in the first 4 to 6 postoperative months with little further resorption. In prevention of negative sequelae of protruding implants, timing of osteosynthesis material removal after this period of high bone remodeling activity is recommended. The resorption rate showed no correlation to clinical outcome.
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Affiliation(s)
- Jean-Pierre Johner
- Resident, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland.
| | - Harald Essig
- Senior physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Andreas Neff
- Professor, Department of Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Germany
| | - Maximilian E H Wagner
- Attending physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Michael Blumer
- Attending physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Thomas Gander
- Senior physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
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Halling F, Neff A, Ziebart T. Local Anesthetic Usage Among Dentists: German and International Data. Anesth Prog 2021; 68:19-25. [PMID: 33827123 DOI: 10.2344/anpr-67-03-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 06/12/2020] [Indexed: 11/11/2022] Open
Abstract
The aim of this study was to analyze the use of dental local anesthetics in Germany compared with international data. The type and distribution of dental local anesthetics and added vasoconstrictors based on a representative sample of German dentists itemized over a period of 7 years (2011 to 2017) were evaluated and statistically analyzed. The results were compared with international dental local anesthetic consumption data published since 2005. With a consistent market share of nearly 98%, articaine was the first-line local dental anesthetic agent in Germany. During the investigation period, German dental local anesthetics with epinephrine 1:200,000 had ∼50% market shares, whereas formulations with epinephrine 1:100,000 had 40% to 45% market shares. Articaine, with market shares between 38% and 81%, was also the preferred anesthetic agent in various other countries, with the notable exceptions of the United Kingdom and the United States, where lidocaine was the preferred local anesthetic agent. Epinephrine was the preferred vasoconstrictor internationally, similar to Germany. The larger market share of higher concentrated epinephrine 1:100,000 was remarkable, considering the increasing number of medically compromised patients. Increased consideration for using agents with reduced dosages of epinephrine (1:200,000) is generally recommended.
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Affiliation(s)
- Frank Halling
- Assistant Professor, Private Practice, Gesundheitszentrum Fulda, Fulda, Germany, and Department of Maxillofacial Surgery, University Hospital, Marburg, Germany
| | - Andreas Neff
- Professor, Department of Maxillofacial Surgery, University Hospital, Marburg, Germany
| | - Thomas Ziebart
- Assistant Professor, Department of Maxillofacial Surgery, University Hospital, Marburg, Germany
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Hirjak D, Vavro M, Dvoranova B, Galis B, Simko K, Malicek L, Machon V, Neff A. Periangular transmasseteric infraparotid approach in the treatment of condylar-base and low condylar‑neck fractures. ACTA ACUST UNITED AC 2021; 122:184-189. [PMID: 33618526 DOI: 10.4149/bll_2021_029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM Mandibular condylar fractures account for 25 to 52 % of all mandibular fractures. Though current literature favors open reduction and internal fixation (ORIF) of condylar‑base and low condylar‑neck fractures, extraoral approaches are usually considered to be complicated by the risk of facial nerve injury and other possible complications. This study was undertaken to demonstrate that the periangular transmasseteric infraparotid surgical approach (TMIP) to condylar‑base and low condylar‑neck fractures provides excellent access to the bony fragments with minimal risk of complications such as facial nerve and parotid gland injury. PATIENTS In the period from January 2010 to December 2018, 81patients (96 fractures) with condylar‑base and low condylar‑neck fractures underwent ORIF via periangular transmasseteric infraparotid surgical approach. RESULTS The results of this retrospective study showed minimal postoperative complications. The periangular transmasseteric infraparotid surgical approach allowed precise anatomic repositioning and fixation of the bony fragments in almost all cases except for two juvenile cases with noticeable scars and one case with plate fracture. There were no transient or permanent facial nerve palsies, parotid gland or salivary fistulae complications during a 12‑month follow‑up period. CONCLUSION The periangular infraparotid transmasseteric approach to ORIF of condylar‑base and low condylar‑neck fractures is an effective and safe approach allowing accurate anatomic reposition and fixation of the fragments with minimum surgical complications (Tab. 1, Fig. 12, Ref. 21).
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Pitak-Arnnop P, Subbalekha K, Meningaud JP, Sirintawat N, Auychai P, Tangmanee C, Wunsch A, Neff A. Factors associated with epiphora following orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty. J Surg Oncol 2021; 123:1246-1252. [PMID: 33523470 DOI: 10.1002/jso.26408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE The aims of the study were to estimate the frequency of epiphora and to identify factors associated with epiphora after orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty (OSOSM-MWFILB). METHODS We performed a retrospective cohort study enrolling a sample derived from the patient population undergoing OSM-MWFILB over a 7-year period. The predictor variables were grouped into demographic, related health status, anatomic, tumor-specific, and therapeutic categories. The primary outcome variable was the presence of postmaxillectomy epiphora (PME). Descriptive, univariate, and multivariate regression mixed-effect models were computed. RESULTS The study sample was composed of 134 patients (46.3% females; 71.6% squamous cell carcinomas) with a mean age of 64.7 ± 12.2 years. There were 23 (17.2%) PME events, which were significantly associated with eight variables: male gender, poor general health (ASA III-IV), large vertical defect (Brown and Shaw's class III-IV), squamous cell carcinoma tumor type, big tumor size (T3-4), cervical lymph node metastasis (N1-2), long operating time > 3 h, and adjuvant radio(chemo)therapy in both univariate mixed regression and multivariate Cox hazards analyses. Healing of PME in irradiated patients was significantly delayed. CONCLUSIONS Ophthalmologic consequences in patients undergoing OSM-MWFILB require particular attention, especially in case of advanced tumors, multiple comorbidities, or long surgery with postoperative radio(chemo)therapy. This emphasizes the importance of appropriate cooperation between the surgeons and ophthalmic colleagues.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, Campus Marburg, UKGM GmbH, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Esthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Prim Auychai
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Annette Wunsch
- Department of Otolaryngology/Head and Neck Surgery, Division of Oral and Maxillofacial Surgery, Faculty of Medicine Campus Trier, Klinikum Mutterhaus der Borromäerinnen Mitte, Johannes Gutenberg University of Mainz, Trier, Germany
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, Campus Marburg, UKGM GmbH, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Pavlychuk T, Chernogorskyi D, Chepurnyi Y, Neff A, Kopchak A. Biomechanical evaluation of type p condylar head osteosynthesis using conventional small-fragment screws reinforced by a patient specific two-component plate. Head Face Med 2020; 16:25. [PMID: 33076933 PMCID: PMC7574441 DOI: 10.1186/s13005-020-00236-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate via finite element analysis (FEA) the biomechanical behavior of conventional small-fragment screws reinforced by a patient-specific plate in type p condylar head. METHODS A finite element model of the mandible was created using Mimics 12.1 software. A type p condylar head fracture was simulated in the right condyle, and the left condyle was used as a control. Two patterns of fixation were investigated: conventional two-screw fixation and the same fixation system reinforced with a small, patient-specific plate. Surface models were imported into the software Ansys 5.7for further volume mesh generation. RESULTS The highest stress gradients were observed in the cortical layer of the lateral fragment, located near the screw. The conventional fixation method resulted in equivalent stresses 2 to 10 times greater than the reinforced method. Rigidity of fixation in the reinforced method increased up to 1.25-3 times compared to the conventional two-screw technique. CONCLUSION This study's findings suggest significant benefits in unfavorable biomechanical conditions from reinforcement of the standard two-screw fixation of condylar head fractures with a small, patient-specific plate acting as a washer.
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Affiliation(s)
- Tetiana Pavlychuk
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine.
| | - Denis Chernogorskyi
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | - Yurii Chepurnyi
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Philipps University Marburg, Marbug, Germany
| | - Andrii Kopchak
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
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Hirjak D, Dvoranova B, Reyneke JP, Machon M, Neff A. Condylar position and mandibular function after bilateral sagittal split osteotomy. ACTA ACUST UNITED AC 2020; 121:379-385. [PMID: 32484700 DOI: 10.4149/bll_2020_062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM The purpose of this retrospective study was to perform an evaluation of postoperative positional changes of the condyle and mandibular function after bilateral sagittal split osteotomy (BSSO) with manual proximal segment positioning. PATIENTS 45 patients were divided into the 2 groups ‒ G1 (advancement ‒ 14 patients) and G2 (setback - 31 patients). Rigid internal fixation screws were utilized in all cases. Inclusion criteria were only BSSO, no TMJ symptoms preoperatively and age 18 or older. RESULTS The differences between pre- and postoperative condyle position were evaluated using measurements taken from preoperative CT scans and compared to CT scans made a minimum of 6 months postoperatively. The positional changes in both the axial and sagittal planes were measured and compared. The recovery of mandibular function was evaluated by measuring maximal interincisal opening (MIO). The results revealed that condylar positional changes after BSSO in both groups were minimal and not significantly different for all three dimensions measured. The recovery of mandibular function was faster in the group G2 than in the group G1. Mandibular function reached almost preoperative level in 6-12 months postoperatively in both groups. CONCLUSION The results demonstrated that following BSSO, only insignificant condylar displacement and functional changes occurred within 6 to 12 months postoperatively (Tab. 4, Fig. 2, Ref. 47).
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Pavlychuk T, Chernogorskyi D, Chepurnyi Y, Neff A, Kopchak A. Application of CAD/CAM technology for surgical treatment of condylar head fractures: A preliminary study. J Oral Biol Craniofac Res 2020; 10:608-614. [PMID: 32963953 DOI: 10.1016/j.jobcr.2020.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives The aim of the present study was to improve the accuracy and reliability of ORIF in patients with condylar head fractures (CHFs) by developing a design for patient specific fixators, navigation and repositioning guides, as well as the algorithms of their clinical application. Materials and methods 14 patients with 16 CHFs were treated by ORIF with the use of CAD/CAM technology. After virtual reduction of the bony fragments, the appropriate length and diameter of the screws was chosen. In biomechanically unfavorable cases (type p) patient specific reinforcement plates were used together with the positional screws for reinforcement of the bone-fixator system. And in cases of severely comminuted fractures patient specific 3-D plate was applied. Results The CT data, obtained immediately after the operation revealed the good anatomical reduction. Any deviations of the small fragments noted were near 1 mm in all cases. Postoperative clinical examination at 3 months follow up showed good occlusion and mouth opening not less than 3 cm in all patients. The lateral and anterior mobility of the mandible was restored with small limitations of protrusive mobility in 1 case. All the patients were satisfied with the outcomes. Conclusions The application of the CAD/CAM technologies and the new design of the surgical guides and patient specific reinforcement plates for CHFs helps to improve the accuracy and quality of fragments reduction and stability of fixation with minimal risks of intraoperative complications. Clinical relevance CAD/CAM technologies improve the clinical effectiveness of treatment patients with the CHFs.
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Affiliation(s)
- Tetiana Pavlychuk
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | - Denis Chernogorskyi
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | - Yurii Chepurnyi
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Philipps University Marburg, Germany
| | - Andrii Kopchak
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
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Pitak-Arnnop P, Witohendro LK, Meningaud JP, Subbalekha K, Iamaroon A, Sirintawat N, Klaisiri A, Neff A. Which characteristics can be expected from p16+-squamous cell carcinomas of the posterior oral cavity and oropharynx? – Distinctive results from Central Germany. Journal of Stomatology, Oral and Maxillofacial Surgery 2020; 121:213-218. [DOI: 10.1016/j.jormas.2019.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/02/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
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