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van Vulpen JK, Eijkelenkamp H, Wessels F, Mulder S, Meijer GJ, Intven MPW. MR-Guided Stereotactic Ablative Body Radiotherapy for Pancreatic Oligometastases from Renal Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e112. [PMID: 37784652 DOI: 10.1016/j.ijrobp.2023.06.892] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients with pancreatic metastases from renal cell carcinoma (RCC) have been reported to have an unusually favorable prognosis. Traditionally, treatment for these pancreatic oligometastases comprises either surgical resection or systemic therapy. However, stereotactic ablative body radiotherapy (SAbR) may be an effective, non-invasive alternative strategy, provided that it shows acceptable toxicity and high local control rates among treated patients. MATERIALS/METHODS We reviewed all patients treated with MR-guided SABR for pancreatic oligometastases from renal cell carcinoma at a single institute. We explored adverse events (AE), freedom from local progression (FFLP), progression-free survival (PFS), and freedom from start of systemic therapy (FFST) among treated patients. The Kaplan-Meier method was used to describe the time-to-event endpoints. RESULTS From June 2019 to September 2022, we identified 11 patients treated with MR-guided SAbR to 31 pancreatic oligometastases from RCC. Patients had a mean age of 65.6 years (±6.8) and had a median of 3 irradiated pancreatic metastases (range 1-7). Metastases were treated with 5 fractions of 7 Gy (n = 1 metastasis) or 8 Gy (n = 30 metastases) per fraction. One grade 3 adverse event (bleeding) was observed. At a median follow-up of 10.5 months (range 5-46 months), estimated FFLP at 1 year was 100%. 1y-PFS was 83% (95% CI 58-100%), and 1y-FFST was 91% (95% CI 75-100%). CONCLUSION First exploration of MR-guided SAbR to pancreatic oligometastases from RCC indicates that it can be an effective and safe treatment option. Moreover, MR-guided SAbR may facilitate deferral of systemic therapy initiation in this select group of patients with favorable prognosis.
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Affiliation(s)
| | - H Eijkelenkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Wessels
- UMC Utrecht, Utrecht, The Netherlands
| | - S Mulder
- Radboud UMC, Nijmegen, The Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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2
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Grimbergen G, Eijkelenkamp H, Bernchou U, Bouchart C, Brown K, Chuter R, Dunlop A, Scripes PG, Heerkens HD, de Leon J, Ng SSW, Renz PB, Shessel A, Intven MPW, Meijer GJ. Toward Global Consensus for MR-Guided Treatment Planning for Pancreatic Tumors on a 1.5 T MR-Linac. Int J Radiat Oncol Biol Phys 2023; 117:e305. [PMID: 37785110 DOI: 10.1016/j.ijrobp.2023.06.2326] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MR-guided SBRT with a 1.5 T MR-Linac is a relatively new therapy for pancreatic tumors with varying expertise levels. Moreover, treatment planning in the upper abdomen can be challenging as target coverage is often compromised by dosimetric constraints of abutting bowel structures. This may lead to large differences between centers in protocols, practices. To increase harmonization a worldwide consortium was founded among 1.5 T MR-Linac users. In this work we report on the outcome of the first phase within this collaboration, which is the assessment of the baseline variation between the treatment planning protocols and subsequent dose distributions. MATERIALS/METHODS Twelve centers across three continents (North America, Europe, and Australia) participated in this consortium. Each center was sent the same two anonymized data sets reflecting two cases of locally advanced pancreatic cancer of different complexity levels. The data sets included a CT scan, a predefined structure set containing the gross target volume (GTV) and the OARs, a brief medical history, tumor motion characteristics, and auxiliary CT and MR imaging. Centers were asked to create an MRgRT treatment plan according to their clinical five-fraction SBRT protocol, using their institutional margin structures, beam setup, target prescriptions, and OAR constraints. Key DVH parameters that were evaluated are D99%, D90%, D50%, D1% for the GTV and D0.5cc for the duodenum, small bowel, and stomach. RESULTS In general, large variations were observed in planning objectives and machine settings yielding widely varying inhomogeneous dose distributions to both the tumor and organs at risk (Table 1). This was especially manifest for case 2 where the tumor abutted with both the duodenum and small bowel over a trajectory of multiple centimeters. Not only were different trade-offs between target coverage and OAR sparing observed, but also different strategies for optimizing the integral dose to the tumor. CONCLUSION These results indicate a large variety in the treatment planning strategies that could well translate to differences in outcome. Based on this first evaluation, the consortium will work towards a collective consensus protocol with a second evaluation round after internal discussions.
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Affiliation(s)
- G Grimbergen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Eijkelenkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - U Bernchou
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - C Bouchart
- Department of Radiation Oncology, HUB Institut Jules Bordet, Brussels, Belgium
| | - K Brown
- Department of Radiation Oncology, ONJ Centre, Austin Hospital, Heidelberg, VIC, Australia
| | - R Chuter
- The Christie NHS Foundation, Manchester, United Kingdom
| | - A Dunlop
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - P Godoy Scripes
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - H D Heerkens
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J de Leon
- GenesisCare, Alexandria, NSW, Australia
| | - S S W Ng
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - P B Renz
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - A Shessel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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3
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Verstraeten J, Slootweg PJ, Cuijpers VM, Meijer GJ. Do dental implants facilitate bone invasion in patients with oral squamous cell carcinoma? A case series. Int J Oral Maxillofac Surg 2023; 52:413-416. [PMID: 36008220 DOI: 10.1016/j.ijom.2022.08.004] [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: 03/12/2022] [Revised: 06/19/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
Osseointegrated dental implants in the vicinity of oral squamous cell carcinoma (OSCC) will become more common given the increasing popularity of dental implants. Reports and studies of OSCC around dental implants are rare, as is the topic of how to handle OSCC surgically when implants are in contact with the tumour. In view of this uncertainty, a histological study was performed to assess tumour behaviour around implants. The aim was to determine whether an implant facilitates inward growth of the tumour and how this should be taken into account during staging and treatment planning. A total of 20 specimens were collected. The implants were macroscopically in contact with OSCC in 13 of the 20 specimens. Histologically, tumour tissue near the implant was indeed confirmed in nine of these cases. In seven cases, tumour invasion had led to resorption of the underlying jaw bone; tumour between the bone-implant interface was identified in only two of these cases, but without downward growth along the implant. In conclusion, no proof was found to confirm that the bone-implant interface is a preferred route for invasion. Therefore, dental implants in the vicinity of OSCC should not influence staging and treatment planning in this regard.
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Affiliation(s)
- J Verstraeten
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Oral and Maxillofacial Surgery, AZ Groeninge, Kortrijk, Belgium.
| | - P J Slootweg
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - V M Cuijpers
- Department of Dentistry-Regenerative Biomaterials, Radboud University Medical Center, Nijmegen, the Netherlands
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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4
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van Goor IWJM, Daamen LA, Besselink MG, Bruynzeel AME, Busch OR, Cirkel GA, Koerkamp BG, Mohammed NH, Heerkens HD, van Laarhoven HWM, Meijer GJ, Nuyttens J, van Santvoort HC, van Tienhoven G, Verkooijen HM, Wilmink JW, Molenaar IQ, Intven MPW. Correction: A nationwide randomized controlled trial on additional treatment for isolated local pancreatic cancer recurrence using stereotactic body radiation therapy (ARCADE). Trials 2023; 24:55. [PMID: 36694252 PMCID: PMC9875523 DOI: 10.1186/s13063-022-07036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- I W J M van Goor
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands. .,Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands.
| | - L A Daamen
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands.,Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - A M E Bruynzeel
- Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Radiation Oncology, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam, the Netherlands
| | - O R Busch
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - G A Cirkel
- Department of Medical Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - B Groot Koerkamp
- Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N Haj Mohammed
- Department of Medical Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - H D Heerkens
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H W M van Laarhoven
- Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Medical Oncology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, the Netherlands
| | - G J Meijer
- Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - J Nuyttens
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - H C van Santvoort
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - G van Tienhoven
- Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Radiation Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - H M Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J W Wilmink
- Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Medical Oncology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, the Netherlands
| | - I Q Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - M P W Intven
- Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands.
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5
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van Goor IWJM, Daamen LA, Besselink MG, Bruynzeel AME, Busch OR, Cirkel GA, Groot Koerkamp B, Haj Mohammed N, Heerkens HD, van Laarhoven HWM, Meijer GJ, Nuyttens J, van Santvoort HC, van Tienhoven G, Verkooijen HM, Wilmink JW, Molenaar IQ, Intven MPW. A nationwide randomized controlled trial on additional treatment for isolated local pancreatic cancer recurrence using stereotactic body radiation therapy (ARCADE). Trials 2022; 23:913. [PMID: 36307892 PMCID: PMC9617359 DOI: 10.1186/s13063-022-06829-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/06/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Disease recurrence is the main cause of mortality after resection of pancreatic ductal adenocarcinoma (PDAC). In 20-30% of resected patients, isolated local PDAC recurrence occurs. Retrospective studies have suggested that stereotactic body radiation therapy (SBRT) might lead to improved local control in these patients, potentially having a beneficial effect on both survival and quality of life. The "nationwide randomized controlled trial on additional treatment for isolated local pancreatic cancer recurrence using stereotactic body radiation therapy" (ARCADE) will investigate the value of SBRT in addition to standard of care in patients with isolated local PDAC recurrence compared to standard of care alone, regarding both survival and quality of life outcomes. METHODS The ARCADE trial is nested within a prospective cohort (Dutch Pancreatic Cancer Project; PACAP) according to the 'Trials within Cohorts' design. All PACAP participants with isolated local PDAC recurrence after primary resection who provided informed consent for being randomized in future studies are eligible. Patients will be randomized for local therapy (5 fractions of 8 Gy SBRT) in addition to standard of care or standard of care alone. In total, 174 patients will be included. The main study endpoint is survival after recurrence. The most important secondary endpoint is quality of life. DISCUSSION It is hypothesized that additional SBRT, compared to standard of care alone, improves survival and quality of life in patients with isolated local recurrence after PDAC resection. TRIAL REGISTRATION ClinicalTrials.gov registration NCT04881487 . Registered on May 11, 2021.
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Affiliation(s)
- I. W. J. M. van Goor
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands ,Nieuwegein, the Netherlands ,Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - L. A. Daamen
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands ,Nieuwegein, the Netherlands ,grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M. G. Besselink
- grid.7177.60000000084992262Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - A. M. E. Bruynzeel
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Radiation Oncology, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam, the Netherlands
| | - O. R. Busch
- grid.7177.60000000084992262Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - G. A. Cirkel
- Department of Medical Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - B. Groot Koerkamp
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - H. D. Heerkens
- grid.10417.330000 0004 0444 9382Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H. W. M. van Laarhoven
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Medical Oncology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, the Netherlands
| | - G. J. Meijer
- Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - J. Nuyttens
- grid.5645.2000000040459992XDepartment of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - H. C. van Santvoort
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands ,Nieuwegein, the Netherlands
| | - G. van Tienhoven
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands ,grid.7177.60000000084992262Department of Radiation Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - H. M. Verkooijen
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J. W. Wilmink
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Medical Oncology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, the Netherlands
| | - I. Q. Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands ,Nieuwegein, the Netherlands
| | - M. P. W. Intven
- Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
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Liebregts JHF, Xi T, Verhamme L, Kramer B, Wouters M, Meijer GJ. [Reconstruction after facial trauma with dento-alveolar injury]. Ned Tijdschr Tandheelkd 2022; 129:169-173. [PMID: 35420274 DOI: 10.5177/ntvt.2022.04.21132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
While abroad, a healthy 36-year-old woman slammed head-on into a rock wall at high speed, resulting in significant facial trauma. The initial trauma care and first aid took place abroad. In the Netherlands, the woman was referred to the Department of Oral and Maxillofacial Surgery (OMFS) for reconstruction of her face and alveolar processes, gingiva and dentition. In view of the seriousness of the injuries, a 3D treatment plan was drawn up in a multidisciplinary collaboration with an OMF surgeon, an implantologist, dentist and dental technician. By making a digital setup of both the top and bottom front in advance, it was possible to work predictably. The first step consisted of bone augmentation by means of an iliac crest graft to reconstruct the major bone defects of the superior and inferior alveolar processes. Implants were then placed in the upper and lower jaws in the ideal position for the suprastructure by means of drill jigs. Within 10 months after the trauma, the implant bridges could be placed on individual zirconia frameworks to optimally restore oral function and aesthetics, completing the reconstruction.
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7
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Boekhoff MR, Defize IL, Borggreve AS, van Hillegersberg R, Kotte ANTJ, Lagendijk JJW, van Lier ALHMW, Ruurda JP, Takahashi N, Mook S, Meijer GJ. CTV-to-PTV margin assessment for esophageal cancer radiotherapy based on an accumulated dose analysis. Radiother Oncol 2021; 161:16-22. [PMID: 33992628 DOI: 10.1016/j.radonc.2021.05.005] [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: 11/27/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aimed to assess the smallest clinical target volume (CTV) to planned target volume (PTV) margins for esophageal cancer radiotherapy using daily online registration to the bony anatomy that yield full dosimetric coverage over the course of treatment. METHODS 29 esophageal cancer patients underwent six T2-weighted MRI scans at weekly intervals. An online bone-match image-guided radiotherapy treatment of five fractions was simulated for each patient. Multiple conformal treatment plans with increasing margins around the CTV were created for each patient. Then, the dose was warped to obtain an accumulated dose per simulated fraction. Full target coverage by 95% of the prescribed dose was assessed as a function of margin expansion in six directions. If target coverage in a single direction was accomplished, then the respective margin remained fixed for the subsequent dose plans. Margins in uncovered directions were increased in a new dose plan until full target coverage was achieved. RESULTS The smallest set of CTV-to-PTV margins that yielded full dosimetric CTV coverage was 8 mm in posterior and right direction, 9 mm in anterior and cranial direction and 10 mm in left and caudal direction for 27 out of 29 patients. In two patients the curvature of the esophagus considerably changed between fractions, which required a 17 and 23 mm margin in right direction. CONCLUSION Accumulated dose analysis revealed that CTV-to-PTV treatment margins of 8, 9 and 10 mm in posterior & right, anterior & cranial and left & caudal direction, respectively, are sufficient to account for interfraction tumor variations over the course of treatment when applying a daily online bone match. However, two patients with extreme esophageal interfraction motion were insufficiently covered with these margins and were identified as patients requiring replanning to achieve full target coverage.
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Affiliation(s)
- M R Boekhoff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - I L Defize
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - A S Borggreve
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - A N T J Kotte
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - J J W Lagendijk
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - A L H M W van Lier
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - N Takahashi
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands.
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8
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Wetzels JGH, Meijer GJ, de Haan AFJ, Merkx MAW, Speksnijder CM. Immediate implant placement in edentulous oral cancer patients: a long-term retrospective analysis of 207 patients. Int J Oral Maxillofac Surg 2021; 50:1521-1528. [PMID: 33642151 DOI: 10.1016/j.ijom.2021.01.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/18/2020] [Accepted: 01/21/2021] [Indexed: 11/18/2022]
Abstract
Although the functional benefits of implants in the rehabilitation of edentulous cancer patients are well-known, most studies report on postponed implant placement. The outcome of immediate implant placement regarding successful rehabilitation, implant loading and survival is unclear. Two hundred and seven edentulous oral cancer patients that received implants during ablative surgery at the Radboud University Medical Centre between 2000 and 2011 were included. Data regarding the oncological treatment, implant placement, follow-up and prosthodontic rehabilitation were recorded retrospectively with a follow-up period of 5-17 years. Functioning implant-retained dentures were made in 73.9% of the patients. Of the surviving patients, 81.9% had functioning dentures after 2 years and 86.3% after 10 years. Patients with ASA score 1 and younger patients were rehabilitated more frequently. The median time of functioning denture placement was 336 days after surgery, with a negative influence of postoperative radiotherapy. Implant survival was 90.7%, and was lower when the implant was placed in a jaw involved in the tumour. Immediate implant placement during oral cancer surgery led to a high number of edentulous patients rehabilitated with implant-retained dentures, which are placed at an early time.
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Affiliation(s)
- J G H Wetzels
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, The Netherlands
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A F J de Haan
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - C M Speksnijder
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, The Netherlands; Julius Center Sciences, University Medical Center Utrecht, Utrecht, The Netherlands.
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9
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Terheyden H, Meijer GJ, Raghoebar GM. Vertical bone augmentation and regular implants versus short implants in the vertically deficient posterior mandible: a systematic review and meta-analysis of randomized studies. Int J Oral Maxillofac Surg 2021; 50:1249-1258. [PMID: 33589294 DOI: 10.1016/j.ijom.2021.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/22/2019] [Revised: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of short dental implants (≤7mm) versus vertical bone augmentation followed by regular dental implants (>7mm) in the deficient posterior mandible. In total, eight RCTs (six using interpositional sandwich grafting and two using a guided bone regeneration technique) were reported in 17 articles at different time points. In the meta-analysis of the sandwich group, the relative risk (RR) for implant loss at 1year was in favour of short implants (RR 0.41, P=0.02), while no significant difference was found at 3 years (RR 0.65, P=0.43), 5 years (RR 1.08, P=0.86), or 8 years (RR 1.53, P=0.52). The risk of complications was in favour of short implants (RR 0.34, P=0.0002), as was the mean difference in marginal bone resorption after 1 year (-0.09mm, P=0.17), 3 years (-0.32mm, P<0.00001), 5 years (-0.65mm, P<0.00001), and 8 years (-0.88, P<0.00001). The mean residual osseointegration length of the implants was between 2.94mm and 4.44mm in the short implants group and between 7.97mm and 8.62mm in the regular implants group after 5 years. In conclusion, in the deficient atrophic posterior mandible, short implants and regular implants demonstrate comparable outcomes within the first 5 years. Patients who are fit for surgery should be informed about the risks and benefits of both options.
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Affiliation(s)
- H Terheyden
- Department of Oral and Maxillofacial Surgery, Red Cross Hospitals of Nordhessen, Kassel, Germany.
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Defize IL, van der Horst S, Bülbul M, Haj Mohammad N, Mook S, Meijer GJ, Brosens LAA, Ruurda JP, van Hillegersberg R. Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy. Ann Surg Oncol 2020; 28:2730-2738. [PMID: 33341917 PMCID: PMC8043929 DOI: 10.1245/s10434-020-09425-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/08/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
Background Patients with esophageal cancer that invades adjacent structures (cT4b) are precluded from surgery and usually treated with definitive chemoradiotherapy (dCRT). dCRT might result in sufficient downstaging to enable a radical resection, possibly improving survival. This study aimed to assess the perioperative and oncologic outcomes of a salvage robot-assisted minimally invasive esophagectomy (RAMIE) in patients with cT4b esophageal cancer after dCRT. Methods Between June 2012 and November 2019, patients who underwent a RAMIE with a gastric conduit reconstruction after completion of dCRT for cT4b esophageal carcinoma were identified from a prospectively maintained surgical database at the University Medical Center Utrecht. Results In total, 24 patients with a histopathologically confirmed T4b adenocarcinoma or squamous cell carcinoma of the esophagus were included. The adjacent organs involved were the tracheobronchial tree (67%), aorta (21%) or both (13%). No conversions or major intraoperative complications were observed. A radical resection was achieved in 22 patients (92%), and a pathologic complete response was observed in 13 (54%) patients. Postoperative grade 2 or higher complications occurred in 20 patients (83%). The disease-free survival at 24 months was 68% for the patients in whom a radical resection was achieved. Conclusion In patients with cT4b esophageal cancer treated with dCRT followed by a salvage RAMIE, a radical resection rate of 92% was achieved, with acceptable complications and promising survival rates. These results demonstrate the feasibility of a curative surgical treatment for patients with initially irresectable esophageal cancer but underscore the importance of a proper preoperative patient selection.
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Affiliation(s)
- I L Defize
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S van der Horst
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M Bülbul
- Department of Pulmonary Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N Haj Mohammad
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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11
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Dieleman FJ, Meijer GJ, Merkx MAW. Does hyperbaric oxygen therapy play a role in the management of osteoradionecrosis? A survey of Dutch oral and maxillofacial surgeons. Int J Oral Maxillofac Surg 2020; 50:273-276. [PMID: 32674903 DOI: 10.1016/j.ijom.2020.06.014] [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: 12/24/2019] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Abstract
For decades, hyperbaric oxygen (HBO) has often been part of the treatment of osteoradionecrosis (ORN), despite controversy in the literature about its efficacy. An online survey was conducted to investigate the use of HBO in the treatment of ORN by Dutch oral and maxillofacial surgeons and to assess their perception of its efficacy. Of the 53 Dutch oral and maxillofacial surgery units contacted, 49 (92%) replied. Thirty-five were not head and neck cancer (HNC) units or preferred partner (PP-HNC) units recognized by the Dutch Head and Neck Association. All HNC and PP-HNC units (group 1) treated ORN patients, compared to only 12 (34%) of the non-HNC units (group 2). The average number of ORN patients seen and treated was higher in group 1. The units in group 1 more often referred patients for HBO therapy (HBOT) than those in group 2 (93% vs 84%). The efficacy of HBOT in curing ORN, rated on a scale of 1 to 5 points, was 3.7 in group 1 and 3.2 in group 2. This survey shows a trend towards centralization of ORN care to more experienced units. These units tend to use HBOT in curing ORN.
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Affiliation(s)
- F J Dieleman
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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12
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Dings JPJ, Vijverberg MA, Hol MKS, Ulrich DJO, de Haan AFJ, Verhage-Damen GW, de Clonie Maclennan-Naphausen MTP, Kruyt IJ, Ghaeminia H, Bruekers-Schipper GB, Ingels KJAO, Dicker GJ, Meijer GJ, Merkx MAW. Autologous versus prosthetic nasal and auricular reconstruction - patient, professional and layperson perceptions. Int J Oral Maxillofac Surg 2020; 49:1271-1278. [PMID: 32173245 DOI: 10.1016/j.ijom.2020.02.010] [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: 08/19/2019] [Revised: 12/27/2019] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
The aim of this study was to retrospectively evaluate the perceptions of aesthetic outcome following the autologous and prosthetic reconstruction of nasal and auricular defects among patients, professionals (oral and maxillofacial surgeons and ear, nose and throat surgeons) and people unfamiliar with reconstructive surgery. The influence of anatomical subunits on the overall perception of nasal and auricular reconstructions was also determined. A total of 119 patients treated for nasal and auricular defects between 1997 and 2016, with a minimum follow-up period of 6 months, were selected, and photographs of 77 of these patients (65%) were presented in a digital survey and reviewed using a standardized questionnaire. No clinically relevant correlations were found between the age or gender of patients (as well as those of the respondents) and their scores. Prosthetic reconstructions of nasal and auricular defects were considered advantageous over autologous reconstructions in terms of the subjective aesthetic outcome in the view of the professionals, in particular oral and maxillofacial surgeons; however, the patients judged both techniques to be equally effective in terms of aesthetics. No anatomical subunits were found to have a significant impact on the overall match of a nasal or auricular reconstruction with the patient's face.
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Affiliation(s)
- J P J Dings
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - M A Vijverberg
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M K S Hol
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D J O Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A F J de Haan
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G W Verhage-Damen
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - I J Kruyt
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Ghaeminia
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - K J A O Ingels
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G J Dicker
- Department of Oral and Maxillofacial Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Dings JP, Verhamme L, Merkx MA, Xi T, Meijer GJ, Maal TJ. Reliability and accuracy of cone beam computed tomography versus conventional multidetector computed tomography for image-guided craniofacial implant planning: An in vitro study. Int J Oral Maxillofac Implants 2019; 34:665–672. [PMID: 30934042 DOI: 10.11607/jomi.6915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the reliability and accuracy of linear measurements on three-dimensional (3D) cross-sectional images, both acquired with cone beam computed tomography (CBCT) and multi-detector row CT (MDCT). Bone thickness was evaluated with regard to image-guided planning of craniofacial implant surgery. MATERIALS AND METHODS Five dry human skulls were used. Cuts were made with a circular bone saw at the ideal implant positions in the nasal, orbital, and temporal regions prior to acquisition of CBCT and MDCT scans. After imaging examination, bone width was assessed by three independent observers using a caliper and defined as a reference. In the next step, cross-sectional images of the regions with the aforementioned cuts were reconstructed from 3D virtual models generated from the digital DICOM datasets with the use of 3D image-based planning software. Subsequently, linear measurements were performed. The systematic difference and interobserver and intraobserver variation of MDCT and CBCT linear measurements were compared with the physical measurements at different locations in the nasal, orbital, and temporal region, respectively. Also, the potential influence of different gray-level values was investigated. The quantitative accuracy of distance measurements was performed using a two-way analysis of variance (ANOVA) and variance component analyses. Only differences with P values < .05 were considered significant. RESULTS All radiologic measurements showed a significant overestimation of the bony dimensions, reaching more than the used voxel sizes of 0.3 mm for CBCT and 0.5 mm for MDCT. For CBCT, an average measurement bias of 0.39 to 0.53 mm and for MDCT of 0.57 to 0.59 mm was found. MDCT images showed less interobserver variation in linear measurements on cross-sectional images from 3D virtual models compared with CBCT images. Contrast settings statistically significantly influenced linear measurements of bone width for CBCT images (P < .0015) and interobserver variation on MDCT imaging (P < .029). CONCLUSION Both CBCT images (KaVo 3D eXam Imaging System) and MDCT images (Aquilion ONE, Toshiba) showed a highly consistent submillimeter overestimation of the anatomical truth in assessing bone thickness of nasal, orbital, and temporal regions of ex vivo specimens. When using CBCT and MDCT images for presurgical assessment, one should be aware of the overestimation of the cortical bone thickness.
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14
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Vollenbrock SE, Voncken FEM, van Dieren JM, Lambregts DMJ, Maas M, Meijer GJ, Goense L, Mook S, Hartemink KJ, Snaebjornsson P, Ter Beek LC, Verheij M, Aleman BMP, Beets-Tan RGH, Bartels-Rutten A. Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer. Br J Surg 2019; 106:596-605. [PMID: 30802305 PMCID: PMC6594024 DOI: 10.1002/bjs.11094] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 09/19/2018] [Revised: 11/12/2018] [Accepted: 11/26/2018] [Indexed: 01/03/2023]
Abstract
Background Patients with a pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer may benefit from non‐surgical management. The aim of this study was to determine the diagnostic performance of visual response assessment of the primary tumour after nCRT on T2‐weighted (T2W) and diffusion‐weighted (DW) MRI. Methods Patients with locally advanced oesophageal cancer who underwent T2W‐ and DW‐MRI (1·5 T) before and after nCRT in two hospitals, between July 2013 and September 2017, were included in this prospective study. Three radiologists evaluated T2W images retrospectively using a five‐point score for the assessment of residual tumour in a blinded manner and immediately rescored after adding DW‐MRI. Histopathology of the resection specimen was used as the reference standard; ypT0 represented a pCR. Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC) and interobserver agreement were calculated. Results Twelve of 51 patients (24 per cent) had a pCR. The sensitivity and specificity of T2W‐MRI for detection of residual tumour ranged from 90 to 100 and 8 to 25 per cent respectively. Respective values for T2W + DW‐MRI were 90–97 and 42–50 per cent. AUCs for the three readers were 0·65, 0·66 and 0·68 on T2W‐MRI, and 0·71, 0·70 and 0·70 on T2W + DW‐MRI (P = 0·441, P = 0·611 and P = 0·828 for readers 1, 2 and 3 respectively). The κ value for interobserver agreement improved from 0·24–0·55 on T2W‐MRI to 0·55–0·71 with DW‐MRI. Conclusion Preoperative assessment of residual tumour on MRI after nCRT for oesophageal cancer is feasible with high sensitivity, reflecting a low chance of missing residual tumour. However, the specificity was low; this results in overstaging of complete responders as having residual tumour and, consequently, overtreatment.
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Affiliation(s)
- S E Vollenbrock
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - F E M Voncken
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - J M van Dieren
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M Maas
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Goense
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K J Hartemink
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - P Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - L C Ter Beek
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M Verheij
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - B M P Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - A Bartels-Rutten
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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15
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Dings JPJ, Verhamme L, Maal TJJ, Merkx MAW, Meijer GJ. Reliability and accuracy of skin-supported surgical templates for computer-planned craniofacial implant placement, a comparison between surgical templates: With and without bony fixation. J Craniomaxillofac Surg 2019; 47:977-983. [PMID: 30905534 DOI: 10.1016/j.jcms.2019.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/20/2018] [Revised: 12/17/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The purpose is to determine the accuracy of guided implant placement in the orbital, nasal, and auricular region using computer-aided designed stereolithographic skin-supported surgical templates with and without bone fixation pins. MATERIALS AND METHODS Preoperatively, cone-beam CT (CBCT) and multiple detector computed tomography (MDCT) scans were acquired from 10 cadaver heads, followed by virtual planning of implants in the orbital margin, auricular region and nasal floor. Surgical skin-supported templates were digitally designed to allow flapless implant placement. Fixation pins were used for stabilization comprising half of all templates in predetermined bone areas. The accuracy of the surgical templates was validated by comparing the achieved implant location to its virtual planned implant position by calculating the linear and angular deviations. RESULTS Surgical templates with the use of bone fixation pins produced statistically significant greater implant deviations as compared to the non-fixated surgical templates. CONCLUSION The results of this study indicate that significant deviation has to be taken into account when placing cranio-maxillofacial implants using skin-supported surgical templates. Surprisingly, the use of bone-fixated pins worsened the accuracy.
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Affiliation(s)
- J P J Dings
- Dept of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
| | - L Verhamme
- 3D Lab, Dept of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - T J J Maal
- 3D Lab, Dept of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - M A W Merkx
- Dept of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - G J Meijer
- Dept of Implantology and Periodontology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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16
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Borggreve AS, Mook S, Verheij M, Mul VEM, Bergman JJ, Bartels-Rutten A, Ter Beek LC, Beets-Tan RGH, Bennink RJ, van Berge Henegouwen MI, Brosens LAA, Defize IL, van Dieren JM, Dijkstra H, van Hillegersberg R, Hulshof MC, van Laarhoven HWM, Lam MGEH, van Lier ALHMW, Muijs CT, Nagengast WB, Nederveen AJ, Noordzij W, Plukker JTM, van Rossum PSN, Ruurda JP, van Sandick JW, Weusten BLAM, Voncken FEM, Yakar D, Meijer GJ. Preoperative image-guided identification of response to neoadjuvant chemoradiotherapy in esophageal cancer (PRIDE): a multicenter observational study. BMC Cancer 2018; 18:1006. [PMID: 30342494 PMCID: PMC6195948 DOI: 10.1186/s12885-018-4892-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 09/13/2018] [Accepted: 10/03/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Nearly one third of patients undergoing neoadjuvant chemoradiotherapy (nCRT) for locally advanced esophageal cancer have a pathologic complete response (pCR) of the primary tumor upon histopathological evaluation of the resection specimen. The primary aim of this study is to develop a model that predicts the probability of pCR to nCRT in esophageal cancer, based on diffusion-weighted magnetic resonance imaging (DW-MRI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET-CT). Accurate response prediction could lead to a patient-tailored approach with omission of surgery in the future in case of predicted pCR or additional neoadjuvant treatment in case of non-pCR. METHODS The PRIDE study is a prospective, single arm, observational multicenter study designed to develop a multimodal prediction model for histopathological response to nCRT for esophageal cancer. A total of 200 patients with locally advanced esophageal cancer - of which at least 130 patients with adenocarcinoma and at least 61 patients with squamous cell carcinoma - scheduled to receive nCRT followed by esophagectomy will be included. The primary modalities to be incorporated in the prediction model are quantitative parameters derived from MRI and 18F-FDG PET-CT scans, which will be acquired at fixed intervals before, during and after nCRT. Secondary modalities include blood samples for analysis of the presence of circulating tumor DNA (ctDNA) at 3 time-points (before, during and after nCRT), and an endoscopy with (random) bite-on-bite biopsies of the primary tumor site and other suspected lesions in the esophagus as well as an endoscopic ultrasonography (EUS) with fine needle aspiration of suspected lymph nodes after finishing nCRT. The main study endpoint is the performance of the model for pCR prediction. Secondary endpoints include progression-free and overall survival. DISCUSSION If the multimodal PRIDE concept provides high predictive performance for pCR, the results of this study will play an important role in accurate identification of esophageal cancer patients with a pCR to nCRT. These patients might benefit from a patient-tailored approach with omission of surgery in the future. Vice versa, patients with non-pCR might benefit from additional neoadjuvant treatment, or ineffective therapy could be stopped. TRIAL REGISTRATION The article reports on a health care intervention on human participants and was prospectively registered on March 22, 2018 under ClinicalTrials.gov Identifier: NCT03474341 .
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Affiliation(s)
- A S Borggreve
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. .,Department of Surgical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - S Mook
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M Verheij
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - V E M Mul
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GW, Groningen, The Netherlands
| | - J J Bergman
- Department of Gastroenterology, Amsterdam University Medical Centers, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - A Bartels-Rutten
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - L C Ter Beek
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - R G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - R J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M I van Berge Henegouwen
- Department of Surgical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - L A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - I L Defize
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Department of Surgical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J M van Dieren
- Department of Gastroenterology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - H Dijkstra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GW, Groningen, The Netherlands
| | - R van Hillegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M C Hulshof
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M G E H Lam
- Department of Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - A L H M W van Lier
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - C T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GW, Groningen, The Netherlands
| | - W B Nagengast
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GW, Groningen, The Netherlands
| | - A J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - W Noordzij
- Department of Nuclear Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GW, Groningen, The Netherlands
| | - J T M Plukker
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GW, Groningen, The Netherlands
| | - P S N van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J W van Sandick
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - B L A M Weusten
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - F E M Voncken
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - D Yakar
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GW, Groningen, The Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Kerkmeijer LGW, Maspero M, Meijer GJ, van der Voort van Zyp JRN, de Boer HCJ, van den Berg CAT. Magnetic Resonance Imaging only Workflow for Radiotherapy Simulation and Planning in Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:692-701. [PMID: 30244830 DOI: 10.1016/j.clon.2018.08.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 06/07/2018] [Revised: 06/29/2018] [Accepted: 08/21/2018] [Indexed: 01/06/2023]
Abstract
Magnetic resonance imaging (MRI) is often combined with computed tomography (CT) in prostate radiotherapy to optimise delineation of the target and organs-at-risk (OAR) while maintaining accurate dose calculation. Such a dual-modality workflow requires two separate imaging sessions, and it has some fundamental and logistical drawbacks. Due to the availability of new MRI hardware and software solutions, CT examinations can be omitted for prostate radiotherapy simulations. All information for treatment planning, including electron density maps and bony anatomy, can nowadays be obtained with MRI. Such an MRI-only simulation workflow reduces delineation ambiguities, eases planning logistics, and improves patient comfort; however, careful validation of the complete MRI-only workflow is warranted. The first institutes are now adopting this MRI-only workflow for prostate radiotherapy. In this article, we will review technology and workflow requirements for an MRI-only prostate simulation workflow.
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Affiliation(s)
- L G W Kerkmeijer
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands.
| | - M Maspero
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands
| | - G J Meijer
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands
| | | | - H C J de Boer
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands
| | - C A T van den Berg
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands
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Groenendijk E, Staas TA, Graauwmans FEJ, Bronkhorst E, Verhamme L, Maal T, Meijer GJ. Immediate implant placement: the fate of the buccal crest. A retrospective cone beam computed tomography study. Int J Oral Maxillofac Surg 2017; 46:1600-1606. [PMID: 28734634 DOI: 10.1016/j.ijom.2017.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 12/10/2016] [Revised: 04/03/2017] [Accepted: 06/29/2017] [Indexed: 12/25/2022]
Abstract
This retrospective study aimed to analyse the fate of the buccal crest after immediate implant placement (IIP) through the use of cone beam computed tomography (CBCT). In 16 consecutive patients, an implant was placed in a more palatal position after extraction, thereby creating a gap of at least 2mm between the implant and the buccal crest. Subsequently, this gap was filled with a bone substitute. Preoperatively, immediate postoperatively, and late postoperatively, a CBCT was made to measure the thickness of the buccal crest. After application of the bone substitute, the buccal crest increased in thickness from 0.9mm to 2.4mm (mean). At a mean of 103 weeks after IIP, late postoperative CBCT scans showed that the thickness of the buccal crest was compacted to 1.8mm. In the same period, the height of the buccal crest increased by 1.6mm (mean) to, on average, 1.2mm above the implant shoulder. The aesthetic outcome was analysed using the White and Pink Esthetic Score (WES and PES). Both scored high: 8.4 and 11.8, respectively. Within the limitations of this study, the results of this IIP protocol are promising. Long-term prospective research on this topic on a large number of patients is necessary.
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Affiliation(s)
| | - T A Staas
- Dental Implant Clinic, 's-Hertogenbosch, The Netherlands
| | - F E J Graauwmans
- Section Implantology & Periodontology, Department of Dentistry, Radboudumc, Nijmegen, The Netherlands
| | - E Bronkhorst
- Department of Preventive and Curative Dentistry, Radboudumc, Nijmegen, The Netherlands
| | - L Verhamme
- Department of Oral and Maxillofacial Surgery, Radboudumc, Nijmegen, The Netherlands; 3D Facial Imaging research Group, Radboudumc, Nijmegen, The Netherlands
| | - T Maal
- Department of Oral and Maxillofacial Surgery, Radboudumc, Nijmegen, The Netherlands
| | - G J Meijer
- Section Implantology & Periodontology, Department of Dentistry, Radboudumc, Nijmegen, The Netherlands; Department of Preventive and Curative Dentistry, Radboudumc, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboudumc, Nijmegen, The Netherlands; 3D Facial Imaging research Group, Radboudumc, Nijmegen, The Netherlands
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19
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Verhamme LM, Meijer GJ, Soehardi A, Bergé SJ, Xi T, Maal TJJ. An accuracy study of computer-planned implant placement in the augmented maxilla using osteosynthesis screws. Int J Oral Maxillofac Surg 2016; 46:511-517. [PMID: 27887876 DOI: 10.1016/j.ijom.2016.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 04/27/2016] [Revised: 08/12/2016] [Accepted: 10/25/2016] [Indexed: 11/16/2022]
Abstract
Previous research on the accuracy of flapless implant placement of virtually planned implants in the augmented maxilla revealed unfavourable discrepancies between implant planning and placement. By using the osteosynthesis screws placed during the augmentation procedure, the surgical template could be optimally stabilized. The purpose of this study was to validate this method by evaluating its clinically relevant accuracy. Twelve consecutive fully edentulous patients with extreme resorption of the maxilla were treated with a bone augmentation procedure. Virtual implant planning was performed and a surgical template was manufactured. Subsequently, six implants were installed using the surgical template, which was only supported by the osteosynthesis screws. Implant deviations between planning and placement were calculated. A total of 72 implants were installed. Mean deviations found in the mesiodistal direction were 0.817mm at the implant tip and 0.528mm at the implant shoulder. The angular deviation was 2.924°. In the buccolingual direction, a deviation of 1.038mm was registered at the implant tip and 0.633mm at the implant shoulder. The angular deviation was 3.440°. This study showed that implant placement in the augmented maxilla using a surgical template supported by osteosynthesis screws is accurate.
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Affiliation(s)
- L M Verhamme
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Implantology and Periodontology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A Soehardi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - S J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - T Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - T J J Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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20
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Weijs TJ, Goense L, van Rossum PSN, Meijer GJ, van Lier ALHMW, Wessels FJ, Braat MNG, Lips IM, Ruurda JP, Cuesta MA, van Hillegersberg R, Bleys RLAW. The peri-esophageal connective tissue layers and related compartments: visualization by histology and magnetic resonance imaging. J Anat 2016; 230:262-271. [PMID: 27659172 DOI: 10.1111/joa.12552] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 12/16/2022] Open
Abstract
An organized layer of connective tissue coursing from aorta to esophagus was recently discovered in the mediastinum. The relations with other peri-esophageal fascias have not been described and it is unclear whether this layer can be visualized by non-invasive imaging. This study aimed to provide a comprehensive description of the peri-esophageal fascias and determine whether the connective tissue layer between aorta and esophagus can be visualized by magnetic resonance imaging (MRI). First, T2-weighted MRI scanning of the thoracic region of a human cadaver was performed, followed by histological examination of transverse sections of the peri-esophageal tissue between the thyroid gland and the diaphragm. Secondly, pretreatment motion-triggered MRI scans were prospectively obtained from 34 patients with esophageal cancer and independently assessed by two radiologists for the presence and location of the connective tissue layer coursing from aorta to esophagus. A layer of connective tissue coursing from the anterior aspect of the descending aorta to the left lateral aspect of the esophagus, with a thin extension coursing to the right pleural reflection, was visualized ex vivo in the cadaver on MR images, macroscopic tissue sections, and after histologic staining, as well as on in vivo MR images. The layer connecting esophagus and aorta was named 'aorto-esophageal ligament' and the layer connecting aorta to the right pleural reflection 'aorto-pleural ligament'. These connective tissue layers divides the posterior mediastinum in an anterior compartment containing the esophagus, (carinal) lymph nodes and vagus nerve, and a posterior compartment, containing the azygos vein, thoracic duct and occasionally lymph nodes. The anterior compartment was named 'peri-esophageal compartment' and the posterior compartment 'para-aortic compartment'. The connective tissue layers superior to the aortic arch and at the diaphragm corresponded with the currently available anatomic descriptions. This study confirms the existence of the previously described connective tissue layer coursing from aorta to esophagus, challenging the long-standing paradigm that no such structure exists. A comprehensive, detailed description of the peri-esophageal fascias is provided and, furthermore, it is shown that the connective tissue layer coursing from aorta to esophagus can be visualized in vivo by MRI.
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Affiliation(s)
- T J Weijs
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P S N van Rossum
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J Meijer
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A L H M W van Lier
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F J Wessels
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M N G Braat
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I M Lips
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M A Cuesta
- Department of Surgery, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Maspero M, Seevinck PR, Schubert G, Hoesl M, Meijer GJ, Viergever MA, Lagendijk JJW, van den Berg CAT. MO-FG-CAMPUS-JeP2-04: Comparison Study for CT and MR-Only Prostate IMRT Treatment Planning: A Framework for the Estimation of Relative Contribution of Body Contour Discrepancies Tissue Stratification and HU-RED Conversion to the Overall Dose Difference. Med Phys 2016. [DOI: 10.1118/1.4957357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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22
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Ghaeminia H, Hoppenreijs TJM, Xi T, Fennis JP, Maal TJ, Bergé SJ, Meijer GJ. Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial. Clin Oral Investig 2016; 21:71-83. [PMID: 26922634 PMCID: PMC5203820 DOI: 10.1007/s00784-016-1751-1] [Citation(s) in RCA: 18] [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: 12/23/2015] [Accepted: 02/10/2016] [Indexed: 11/24/2022]
Abstract
Objectives The primary aim of the present study was to evaluate the effectiveness of postoperative irrigation of the socket with drinking tap water on inflammatory complications following lower third molar removal. Material and methods A multicenter randomized controlled trial was carried out from June 2013 to June 2014. In one arm of the study, patients were instructed to irrigate the tooth socket and surgical site with a Monoject® Curved 412 Tip Syringe (Tyco/healthcare-Kendall, Mansfield, MA, USA) with tap water. In a second arm of the study, the standard postoperative instructions did not include irrigation instructions. The incidences of alveolar osteitis and wound infection were recorded for each group and analyzed by the Fisher’s exact test. Results A total of 280 patients with 333 mandibular third molars were analyzed. According to the intention-to-treat (ITT) analysis, inflammatory complications occurred in 18 cases in the Monoject® group (11.4 %) compared to 34 cases (19.1 %) in the control group (p = 0.04). These complications were associated with significant worse outcomes regarding quality of life, pain, and trismus and caused significantly more missed days of work or study. Female gender, age >26, bone removal, deep impacted third molars, less experienced surgeons, and a high amount of debris at the surgical site were also identified as risk factors for developing inflammatory complications following lower third molar removal. Conclusion Irrigation of the surgical site with drinking tap water using a curved syringe following removal of third molars is effective in reducing the risk of inflammatory complications. Clinical relevance Water is a very accessible, cost-effective irrigant without side effects and the results from this study have proven that it can be used to reduce the risk of inflammatory complications and associated morbidity following lower third molar removal.
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Affiliation(s)
- H Ghaeminia
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Th J M Hoppenreijs
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - T Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - J P Fennis
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - T J Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - S J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Oral and Maxillofacial Surgery, ZBC Private Clinic Nijmegen, Groenewoudseweg 315, 6524 TX, Nijmegen, The Netherlands
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Implantology & Periodontology, Radboud University Medical Center, Phillips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands
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23
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van Oirschot BAJA, Bronkhorst EM, van den Beucken JJJP, Meijer GJ, Jansen JA, Junker R. A systematic review on the long-term success of calcium phosphate plasma-spray-coated dental implants. Odontology 2016; 104:347-56. [PMID: 26886570 DOI: 10.1007/s10266-015-0230-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 01/31/2015] [Accepted: 11/01/2015] [Indexed: 01/29/2023]
Abstract
The objectives of the current review were (1) to systematically appraise, and (2) to evaluate long-term success data of calcium phosphate (CaP) plasma-spray-coated dental implants in clinical trials with at least 5 years of follow-up. To describe the long-term efficacy of functional implants, the outcome variables were (a) percentage annual complication rate (ACR) and (b) cumulative success rate (CSR), as presented in the selected articles. The electronic search yielded 645 titles. On the basis of the inclusion criteria, 8 studies were finally included. The percentage of implants in function after the first year was estimated to be 98.4 % in the maxilla and 99.2 % in the mandible. The estimates of the weighted mean ACR-percentage increased over the years up to 2.6 (SE 0.7) during the fifth year of function for the maxilla and to 9.4 (SE 8.4) for the mandible in the tenth year of function. After 10 years, the mean percentage of successful implants was estimated to be 71.1 % in the maxilla and 72.2 % in the mandible. The estimates seem to confirm the proposed, long-term progressive bone loss pattern of CaP-ceramic-coated dental implants. Within the limits of this meta-analytic approach to the literature, we conclude that: (1) published long-term success data for calcium phosphate plasma-spray-coated dental implants are limited, (2) comparison of the data is difficult due to differences in success criteria among the studies, and (3) long-term CSRs demonstrate very weak evidence for progressive complications around calcium phosphate plasma-spray-coated dental implants.
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Affiliation(s)
- B A J A van Oirschot
- Department of Biomaterials, College of Dental Sciences, Radboudumc, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - E M Bronkhorst
- Department of Preventive and Curative Dentistry, Radboudumc, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - J J J P van den Beucken
- Department of Biomaterials, College of Dental Sciences, Radboudumc, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - G J Meijer
- Department of Implantology and Periodontology, Radboudumc, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - J A Jansen
- Department of Biomaterials, College of Dental Sciences, Radboudumc, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - R Junker
- Department of Prosthodontics and Biomaterials, Danube Private University, Krems a.d. Donau, Austria
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24
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Heerkens HD, Tseng DSJ, Lips IM, van Santvoort HC, Vriens MR, Hagendoorn J, Meijer GJ, Borel Rinkes IHM, van Vulpen M, Molenaar IQ. Health-related quality of life after pancreatic resection for malignancy. Br J Surg 2015; 103:257-66. [PMID: 26785646 DOI: 10.1002/bjs.10032] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 09/10/2015] [Accepted: 09/17/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Health-related quality of life (QoL) is of major importance in pancreatic cancer, owing to the limited life expectation. The aim of this prospective longitudinal study was to describe QoL in patients undergoing resection for pancreatic or periampullary malignancy. METHODS QoL was measured on a scale of 0-100 in patients who underwent pancreatic resection for malignancy or premalignancy at the University Medical Centre Utrecht before resection, and 1, 3, 6 and 12 months after surgery. Measures consisted of the RAND-36, the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ-C30) and the EORTC pancreatic cancer-specific module (QLQ-PAN26). RESULTS Between March 2012 and November 2013, 68 consecutive patients with a malignancy (59 patients) or premalignancy (9) were included. Physical role restriction, social and emotional domains showed a significant and clinically relevant deterioration directly after operation in 53 per cent (RAND-36, P < 0.001), 63 and 78 per cent (QLQ-C30 and RAND-36 respectively, P < 0.001) and 37 per cent (RAND-36, P < 0.001) of patients respectively. Most domains demonstrated recovery to preoperative values or better at 3 months, except for physical functioning. Emotional functioning at 3, 6 and 12 months was better than at baseline (P < 0.001). Symptom scores revealed a deterioration in vitality, pain (P = 0.002), fatigue (P < 0.001), appetite loss (P < 0.001), altered bowel habit (P = 0.001) and side-effects (P < 0.001) after 1 month. After 3 months, only side-effects were worse than preoperative values (P < 0.001). CONCLUSION QoL after pancreatic resection for malignant and premalignant tumours decreased considerably in the early postoperative phase. Full recovery of QoL took up to 6 months after the operation.
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Affiliation(s)
- H D Heerkens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D S J Tseng
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I M Lips
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H C van Santvoort
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M R Vriens
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Q Molenaar
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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25
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Ghaeminia H, Gerlach NL, Hoppenreijs TJM, Kicken M, Dings JP, Borstlap WA, de Haan T, Bergé SJ, Meijer GJ, Maal TJ. Clinical relevance of cone beam computed tomography in mandibular third molar removal: A multicentre, randomised, controlled trial. J Craniomaxillofac Surg 2015; 43:2158-67. [PMID: 26596360 DOI: 10.1016/j.jcms.2015.10.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 05/23/2015] [Revised: 08/31/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aims of this study were to investigate the effectiveness of cone beam computed tomography (CBCT) compared to panoramic radiography (PR), prior to mandibular third molar removal, in reducing patient morbidity, and to identify risk factors associated with inferior alveolar nerve (IAN) injury. MATERIAL AND METHODS This multicentre, randomised, controlled trial was performed at three centres in the Netherlands. Adults with an increased risk for IAN injury, as diagnosed from PR, were included in the study. In one arm of the study, patients underwent an additional CBCT prior to third molar surgery. In a second arm of the study, no additional radiographs were acquired. The primary outcome measure was the number of patient-reported altered sensations 1 week after surgery. As secondary outcome measures, the number of patients with objective IAN injury, with long-term (>6 months) IAN injury, the occurrence of other postoperative complications, the Oral Health Related Quality of Life-14 (OHIP-14) questionnaire responses, postoperative pain (visual analogue scale score), duration of surgery, number of emergency visits, and number of missed days of work or study were scored. RESULTS A total of 268 patients with 320 mandibular third molars were analysed according to the intention-to-treat principle. The overall incidence of IAN injury 1 week after surgery was 6.3%. No significant differences between CBCT and PR for temporary IAN injury (p = 0.64) and all other secondary outcomes were registered. A lingual position of the mandibular canal (MC) and narrowing, in which the diameter of the MC lumen was decreased at the contact area between the MC and the roots, were significant risk factors for temporary IAN injury. CONCLUSION Although CBCT is a valuable diagnostic adjunct for identification of an increased risk for IAN injury, the use of CBCT does not translate into a reduction of IAN injury and other postoperative complications, after removal of the complete mandibular third molar. In these selected cases of a high risk for IAN injury, an alternative strategy, such as monitoring or a coronectomy, might be more appropriate. (http://clinicaltrials.gov, NCT02071030).
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Affiliation(s)
- H Ghaeminia
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - N L Gerlach
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - Th J M Hoppenreijs
- Rijnstate Hospital Arnhem, Department of Oral and Maxillofacial Surgery, Wagnerlaan 55, 6815AD Arnhem, The Netherlands.
| | - M Kicken
- Rijnstate Hospital Arnhem, Department of Oral and Maxillofacial Surgery, Wagnerlaan 55, 6815AD Arnhem, The Netherlands.
| | - J P Dings
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - W A Borstlap
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands; ZBC Private Clinic Nijmegen, Oral and Maxillofacial Surgery, Groenewoudseweg 315, 6524 TX Nijmegen, The Netherlands.
| | - T de Haan
- Radboud University Medical Center, Department of Health Evidence, Geert Grooteplein-Noord 21, 6525 GA Nijmegen, The Netherlands.
| | - S J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands; ZBC Private Clinic Nijmegen, Oral and Maxillofacial Surgery, Groenewoudseweg 315, 6524 TX Nijmegen, The Netherlands.
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands; Radboud University Medical Center, Implantology & Periodontology, Phillips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands.
| | - T J Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
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26
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van Bilsen MWT, Schreurs R, Meulstee JW, Kuijpers MAR, Meijer GJ, Borstlap WA, Bergé SJ, Maal TJJ. Evaluation of the anterior mandibular donor site one year after secondary reconstruction of an alveolar cleft: 3-dimensional analysis using cone-beam computed tomography. Br J Oral Maxillofac Surg 2015; 53:719-24. [PMID: 26051866 DOI: 10.1016/j.bjoms.2015.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/31/2014] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to analyse changes in the volume of the chin after harvest of a bone graft for secondary reconstruction of an alveolar cleft. Cone-beam computed tomographic (CT) scans of 27 patients taken preoperatively, and immediately and one year postoperatively, were analysed, and 3-dimensional hard-tissue reconstructions made. The hard-tissue segmentation of the scan taken one year postoperatively was subtracted from the segmentation of the preoperative scan to calculate the alteration in the volume of bone at the donor site (chin). A centrally-orientated persistent concavity at the buccal side of the chin was found (mean (range) 160 (0-500) mm(3)). At the lingual side of the chin, a central concavity remained (mean (range) volume 20 (0-80) mm(3)). Remarkably, at the periphery of this concavity there was overgrowth of new bone (mean (range) volume 350 (0-1600) mm(3)). Re-attachment of the muscles of the tongue resulted in a significantly larger central lingual defect one year postoperatively (p=0.01). We also measured minor alterations in volume of the chin at one year. Whether these alterations influence facial appearance and long term bony quality is to be the subject of further research.
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Affiliation(s)
- M W T van Bilsen
- Department of Oral- and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Schreurs
- Department of Oral- and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J W Meulstee
- Department of Oral- and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M A R Kuijpers
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G J Meijer
- Department of Oral- and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W A Borstlap
- Department of Oral- and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S J Bergé
- Department of Oral- and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T J J Maal
- Department of Oral- and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
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Soehardi A, Meijer GJ, Berge SJ, Stoelinga PJW. Lower border bone onlays to augment the severely atrophic (class VI) mandible in preparation for implants: a preliminary report. Int J Oral Maxillofac Surg 2014; 43:1493-9. [PMID: 25017193 DOI: 10.1016/j.ijom.2014.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/14/2013] [Revised: 06/08/2014] [Accepted: 06/10/2014] [Indexed: 11/16/2022]
Abstract
We present the preliminary results of a study involving a group of consecutive patients who underwent lower border onlay grafting, limited to the symphyseal area, in preparation for implant insertion. This technique allows for maximum-sized implants, followed by prosthetic rehabilitation. The main advantage of this method is the minimal risk of damage to the mental nerve. Sixteen patients were followed for a period of 6 months to 4 years and all were free of neurosensory disturbances. Eight had a removable overdenture placed and were satisfied with the result. This surgical approach allows the patient to wear their dentures during the healing period. A further advantage of lower border grafting over intraoral upper border grafting is that mucosal dehiscences are not seen.
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Affiliation(s)
- A Soehardi
- Department of Oral and Maxillofacial Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - S J Berge
- Department of Oral and Maxillofacial Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - P J W Stoelinga
- Department of Oral and Maxillofacial Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
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van Heumen CM, Termeer D, Oosterkamp BCM, Meijer GJ. [Incisors with a mind of their own]. Ned Tijdschr Tandheelkd 2014; 121:381-384. [PMID: 25174187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 43-year-old man, known to have hypodontia, was bothered by his over-erupted central incisors. After the placement of implants and the accompanying crown- and bridgework, the central incisors appear to be increasingly over-erupted. The history shows that this phenomenon has already been seen in the past. Three mechanisms can be responsible for the over-eruption, specifically: continuous facial growth, over-eruption of both central incisors in the maxilla as a consequence of agenesis of opposing dentition and relapse of the orthodontic treatment as a result of the fact that orthodontic retention is not readily possible. After the central incisors were first cut in such a way that an acceptable incisal line has again been formed, the single-unit fixed dental prostheses on the front elements were replaced with porcelain ones.
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Franken WMG, van Heumen CCM, van Engelen M, Meijer GJ. [Lack of retention of the upper denture: is placement of 2 palatal implants the solution?]. Ned Tijdschr Tandheelkd 2014; 121:200-202. [PMID: 24881260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 72-year-old man, edentulous in the maxilla for 20 years, presented himself at his dentist in 2006 with complaints concerning retention of his upper denture. The placement of implants was only possible if bone augmentation was undertaken; this was definitively rejected by the man. As an alternative, Muchor anchors were placed, but these did not provide an adequate solution to the retention problem. In the end, 2 palatal implants were placed, with magnetic anchoring. One year later, the man was very satisfied with this solution.
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Perdijk FBT, Meijer GJ, Soehardi A, Koole R. A lower border augmentation technique to allow implant placement after a bilateral mandibular fracture as a complication of vertical distraction osteogenesis: a case report. Int J Oral Maxillofac Surg 2013; 42:897-900. [PMID: 23523623 DOI: 10.1016/j.ijom.2013.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 11/16/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
As with other techniques, vertical distraction osteogenesis (VDO) can also induce complications. The case of a patient with a residual alveolar ridge in the symphyseal area of 8 mm is presented. After performing VDO, the patient returned at 1-day postoperatively complaining of pain and dislocation of the distractor device, due to a fracture of the lower mandibular segment on the right side. After removal of the distractor device and application of osteosynthesis plates, the patient returned 2 weeks later due to a second fracture of the lower segment, yet on the left side. After removing the osteosynthesis material, stabilization of the mandible was achieved with an acrylic splint, which was fixated with peri-mandibular wiring. Finally, reconstruction was accomplished by lower border onlay grafting, limited to the symphyseal area, in preparation for implant insertion. Ultimately, after a healing period of 5 months, two endosseous implants were installed. The patient's function has remained satisfactory for 3 years. Reinforcement of the extreme resorbed edentulous mandible after fracture healing by lower border bone augmentation can be a reliable method to allow implant installation in a second stage.
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Affiliation(s)
- F B T Perdijk
- Department of Oral and Maxillofacial Surgery, Hospital Gelderse Vallei, Ede, The Netherlands.
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31
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Klijn RJ, van den Beucken JJJP, Bronkhorst EM, Berge SJ, Meijer GJ, Jansen JA. Predictive value of ridge dimensions on autologous bone graft resorption in staged maxillary sinus augmentation surgery using Cone-Beam CT. Clin Oral Implants Res 2011; 23:409-15. [PMID: 22092724 DOI: 10.1111/j.1600-0501.2011.02342.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION No studies are available that provide predictive parameters regarding the expected amount of resorption after maxillary sinus augmentation surgery using autologous bone grafts. Therefore, the aim of this study was to determine parameters influencing the outcome of the bone graft resorption process. MATERIAL AND METHODS In 20 patients, three-dimensional analysis of alveolar ridge dimensions and bone graft volume change in the atrophic posterior maxilla was performed by Cone-Beam Computerized Tomography imaging. Ridge dimensions were assessed before maxillary sinus augmentation surgery. Bone graft volumes were compared after maxillary sinus floor augmentation surgery and a graft healing interval of several months. To analyze the relation between bone volume changes with the independent variables, patients' gender, age, alveolar crest height and width, and graft healing time interval, a multi-level extension of linear regression was applied. RESULTS A residual bone height of 6.0 mm (SD = 3.6 mm) and 6.2 mm (SD = 3.6 mm) was found at the left and right sides, respectively. Moreover, alveolar bone widths of 6.5 mm (SD = 2.2 mm) and 7.0 mm (SD = 2.3 mm) at the premolars, and 8.8 mm (SD = 2.2 mm) and 8.9 mm (SD = 2.5 mm) at the molars regions were found at the left and right site, respectively. Bone graft volume decreased by 25.0% (SD = 21.0%) after 4.7 months (SD = 2.7, median = 4.0 months) of healing time. The variables "age" (P = 0.009) and mean alveolar crest "bone height" (P = 0.043), showed a significant influence on bone graft resorption. A decrease of 1.0% (SE = 0.3%) of bone graft resorption was found for each year the patient grew older, and an increase in bone graft resorption of 1.8% (SE = 0.8%) was found for each mm of original bone height before sinus floor augmentation. CONCLUSIONS Graft resorption occurs when using autologous bone grafts for maxillary sinus augmentation. Alveolar crest bone height and patient age have a significant effect on graft resorption, with increased resorption for higher alveolar crest bone height and decreased resorption for older patients. Consequently, patient characteristics that affect the process of bone graft resorption should be given full consideration, when performing sinus augmentation surgery.
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Affiliation(s)
- R J Klijn
- Department of Biomaterials, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Dings JPJ, Maal TJ, Muradin MS, Ingels KJ, Klevering BJ, Koole R, Merkx MA, Meijer GJ. Extra-oral implants: insertion per- or post-ablation? Oral Oncol 2011; 47:1074-8. [PMID: 21835682 DOI: 10.1016/j.oraloncology.2011.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 07/14/2011] [Accepted: 07/18/2011] [Indexed: 11/30/2022]
Abstract
Although the benefit of extra-oral implants in the reconstruction of maxillofacial oncological defects is undisputable, some relevant issues need to be clarified. The purpose of this retrospective study was to evaluate the relationship between implants placed during ablation (DA-implants) and after ablation (AA-implants) of the tumor with respect to implant survival. In total, 103 implants were assessed: 44 nasal implants (17 patients) and 59 orbital implants (18 patients). All patients received their implant-retained maxillofacial epithesis between 1997 and 2010, with a mean follow-up of 35 months (range 8-156 months). The survival rate of DA-implants was 90.0% for the orbital region and 93.5% for the nasal region. The survival rate of the AA-implants for the orbital and the nasal region was 82.8% and 61.5%, respectively. This study shows a significant higher survival rate of extra-oral implants placed during ablative surgery compared to implants in a later stage (p=0.044), thereby stressing the importance of installing extra-oral implants during the ablative surgical session.
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Affiliation(s)
- J P J Dings
- Dept. of Oral and Maxillofacial Surgery 590, Radboud University Nijmegen Medical Center, PO Box 9101, NL 6500 HB Nijmegen, The Netherlands.
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Klijn RJ, Hoekstra JWM, Van Den Beucken JJJP, Meijer GJ, Jansen JA. Maxillary sinus augmentation with microstructured tricalcium phosphate ceramic in sheep. Clin Oral Implants Res 2011; 23:274-80. [DOI: 10.1111/j.1600-0501.2011.02190.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schouten C, Meijer GJ, van den Beucken JJJP, Spauwen PHM, Jansen JA. A novel implantation model for evaluation of bone healing response to dental implants: the goat iliac crest. Clin Oral Implants Res 2010; 21:414-23. [DOI: 10.1111/j.1600-0501.2009.01872.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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35
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Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Bergé SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg 2009; 38:964-71. [PMID: 19640685 DOI: 10.1016/j.ijom.2009.06.007] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Revised: 05/12/2009] [Accepted: 06/01/2009] [Indexed: 11/16/2022]
Abstract
This study investigated the diagnostic accuracy of cone beam computed tomography (CBCT) compared to panoramic radiography in determining the anatomical position of the impacted third molar in relation with the mandibular canal. The study sample comprised 53 third molars from 40 patients with an increased risk of inferior alveolar nerve (IAN) injury. The panoramic and CBCT features (predictive variables) were correlated with IAN exposure and injury (outcome variables). Sensitivity and specificity of modalities in predicting IAN exposure were compared. The IAN was exposed in 23 cases during third molar removal and injury occurred in 5 patients. No significant difference in sensitivity and specificity was found between both modalities in predicting IAN exposure. To date, lingual position of the mandibular canal was significantly associated with IAN injury. CBCT was not more accurate at predicting IAN exposure during third molar removal, however, did elucidate the 3D relationship of the third molar root to the mandibular canal; the coronal sections allowed a bucco-lingual appreciation of the mandibular canal to identify cases in which a lingually placed IAN is at risk during surgery. This observation dictates the surgical approach how to remove the third molar, so the IAN will not be subjected to pressure.
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Affiliation(s)
- H Ghaeminia
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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36
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Schouten C, Meijer GJ, van den Beucken JJJP, Spauwen PHM, Jansen JA. Effects of implant geometry, surface properties, and TGF-β1 on peri-implant bone response: an experimental study in goats. Clin Oral Implants Res 2009; 20:421-9. [DOI: 10.1111/j.1600-0501.2008.01657.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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37
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Créton MA, Cune MS, de Putter C, Verhoeven JW, Meijer GJ. [A description of a population with severe oligodontia]. Ned Tijdschr Tandheelkd 2009; 116:119-123. [PMID: 19382538] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The dentition of 116 patients with a non-syndromic form of oligodontia was characterized. For this purpose use was made of the so-called Tooth Agenesis Code (TAC), with which the various patterns of missing teeth can be indicated with a unique number. Oligodontia can present itself in very diverse ways. Only 3 patterns were seen (2 times) among these 116 patients. Considered per quadrant, in the upper jaw, on the one hand, agenesis of both premolars and the lateral incisor was most common and, on the other, the absence of all teeth except the central incisor and the first molar. In the lower jaw, agenesis of the second or of both premolars was most common. Evaluating treatments and formulating standards of restoration in the treatment of patients with severe oligodontia are methodological challenges. Homogeneous, comparable sub-groups of patients of any size are difficult to construct due to the low prevalence of severe oligodontia and the diversity of patterns of agenesis when the whole mouth is taken into consideration.
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Affiliation(s)
- M A Créton
- Uit de zorgeenheid Mondziekten, Kaakchirurgie en Bijzondere Tandheelkunde van het Universitair Medisch Centrum Utrecht.
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38
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Meijer GJ, Cune MS. [Surgical dilemmas. Medical restrictions and risk factors]. Ned Tijdschr Tandheelkd 2008; 115:643-651. [PMID: 19149131] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In principle, only patients with an ASA (American Society of Anaesthesiologists)-score I or II qualify for an elective surgical procedure, such as an implantation treatment. Surgical risks are weighed against the potential benefits offered by oral implants. Counter-indications to implant rehabilitation include recent myocardial infarction and cerebrovascular accident, immunosuppression, active treatment of malignancy, drug abuse, as well as long-standing intravenous bisphosphonate use. In the case of patients with an endocarditis risk, and also in the case of patients with an orthopedic prosthesis, implants should be placed with some reluctance. If the decision is made for treatment, then consultation with the treating specialist is recommended. Beside absolute counter-indications, there are also conditions which compromise the success of an implant treatment, such as radiation of the jaw or long-term smoking. Concerning the effect which medical conditions have on the life-expectancy of the implant, little is known. There appear to be few existing factors which actually have a negative influence on the chance that an implant will survive.
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Affiliation(s)
- G J Meijer
- Mondziekten, Kaak- en Aangezichtchirurgie van het Universitair Medisch Centrum St Radboud Nijmegen, Nijmegen.
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39
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Cune MS, de Putter C, Verhoeven JW, Meijer GJ. [Prosthetic dilemmas. Connecting natural teeth and implants]. Ned Tijdschr Tandheelkd 2008; 115:613-619. [PMID: 19058506] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In clinical practice, the prognosis seems, with some reservations, to be comparable for tooth-implant and implant-implant supported bridges in the middle-long term.This conclusion seems particularly valid for tooth-implant bridges in free-end situations, where a single implant is connected with a tooth. Prerequisites are a healthy tooth abutment, a pontic length not exceeding the width of a bicuspid, a rigid connection between implant and tooth and the use of strong cement.
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Affiliation(s)
- M S Cune
- Zorgeenheid Mondziekten, Kaakchirurgie en Bijzondere Tandheelkunde van her UMC Utrecht.
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40
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Nienhuijs MEL, Meijer GJ, Merkx MAW, Walboomers XF, Jansen JA. [Bone substitutes, growth factors and distraction osteogenesis]. Ned Tijdschr Tandheelkd 2008; 115:297-304. [PMID: 18618983] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Up to the present time, bone transplants are commonly used to reconstruct bone defects. Recently, several bone substitutes have been suggested to overcome the disadvantages of the procedure of bone harvesting. However, research reveals that an autogenous bone graft is still the gold standard. To replicate the structure and function of natural bone, growth factors or even living, bone-forming cells can be added to enhance the formation of new bone. In that case, one speaks of cell-based tissue-substition. As an alternative distraction osteogenesis, a mechanical-based way of tissue engineering is suggested. In this procedure, tissue-generation takes place without the addition of external material. A combination of both tissue-substitution techniques, consisting of the addition of bone-replacement materials or growth factors during distraction osteogenesis, has also been evaluated in research on animals, although not with unequivocal results.
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Affiliation(s)
- M E L Nienhuijs
- Afdeling Mond-, Kaak- en Aangezichtschirurgie, Universitair Medisch Centrum St Radboud te Nijmegen
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41
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Perdijk FBT, Meijer GJ, Strijen PJV, Koole R. Complications in alveolar distraction osteogenesis of the atrophic mandible. Int J Oral Maxillofac Surg 2007; 36:916-21. [PMID: 17919888 DOI: 10.1016/j.ijom.2007.01.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 10/29/2006] [Accepted: 01/23/2007] [Indexed: 11/27/2022]
Abstract
To improve the starting point for placement of dental implants, 45 patients suffering from atrophied edentulous mandibles, with a vertical height varying between 7.3 and 15.8mm, were treated by alveolar vertical distraction osteogenesis (VDO). The mean follow-up period was 3 years, ranging from 1 to 7 years. Associated complications, as occurred during instalment of the distractor device, VDO period and consolidation phase, and also after dental implant placement, were evaluated. Observed complications were: early fractures (2%), late fractures (17%), bleeding or haematoma (4%), infections (6%), skin perforation (2%), mucosal dehiscence (8%), sensory disturbances (28%), sagging chin (13%) and failure of dental implants (13%). In 10 patients 2 complications and in 1 patient 3 complications were monitored. All complications occurred in the first year. It is concluded that VDO to restore vertical bone height in patients with mandibular atrophy is a surgically delicate technique with a high risk of various complications. The likelihood of the most striking complication, namely fracture occurrence, increases with decreasing residual bone height.
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Affiliation(s)
- F B T Perdijk
- Department of Oral and Maxillofacial Surgery, Hospital Gelderse Vallei, Ede, The Netherlands.
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42
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Springer GJ, Meijer GJ, Slootweg P, Geertman ME, Koole R, Cann EMV. [Absence of (jaw)bone may be indicative of malignancy]. Ned Tijdschr Tandheelkd 2007; 114:346-8. [PMID: 17822243] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Following the loss of several molars in the left maxilla, a 73-year-old man asked his general dentist practitioner to restore his chewing efficiency. Initially, reconstruction of the left maxilla with an implant supported fixed partial denture was considered. However, intraorally a soft-tissue swelling was observed extending from the midline of the palate to the left buccal sulcus. A panoramic radiograph showed absence of bone between the oral cavity and the maxillary sinus. At first, after an incision biopsy and histopathologic examination, the condition was diagnosed as nodular fasciitis. However, because of subsequent aggressive growth of the lesion malignancy was suspected. Histopathological examination confirmed the assumption. The lesion appeared to be a sarcoma. The general diagnostic rule is that the aggressive behaviour of a lesion and the absence of a bony delineation on radiographic examination between the oral cavity and the maxillary sinus are signs of malignancy, until evidence to the contrary has been provided.
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Affiliation(s)
- G J Springer
- Afdeling Mondziekten en Kaak- en Aangezichtschirurgie van het Universitair Medisch Centrum Utrecht
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43
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Eniwumide JO, Yuan H, Cartmell SH, Meijer GJ, de Bruijn JD. Ectopic bone formation in bone marrow stem cell seeded calcium phosphate scaffolds as compared to autograft and (cell seeded) allograft. Eur Cell Mater 2007; 14:30-8; discussion 39. [PMID: 17674330 DOI: 10.22203/ecm.v014a03] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Improvements to current therapeutic strategies are needed for the treatment of skeletal defects. Bone tissue engineering offers potential advantages to these strategies. In this study, ectopic bone formation in a range of scaffolds was assessed. Vital autograft and devitalised allograft served as controls and the experimental groups comprised autologous bone marrow derived stem cell seeded allograft, biphasic calcium phosphate (BCP) and tricalcium phosphate (TCP), respectively. All implants were implanted in the back muscle of adult Dutch milk goats for 12 weeks. Micro-computed tomography (microCT) analysis and histomorphometry was performed to evaluate and quantify ectopic bone formation. In good agreement, both microCT and histomorphometric analysis demonstrated a significant increase in bone formation by cell-seeded calcium phosphate scaffolds as compared to the autograft, allograft and cell-seeded allograft implants. An extensive resorption of the autograft, allograft and cell-seeded allograft implants was observed by histology and confirmed by histomorphometry. Cell-seeded TCP implants also showed distinct signs of degradation with histomorphometry and microCT , while the degradation of the cell-seeded BCP implants was negligible. These results indicate that cell-seeded calcium phosphate scaffolds are superior to autograft, allograft or cell-seeded allograft in terms of bone formation at ectopic implantation sites. In addition, the usefulness of microCT for the efficient and non-destructive analysis of mineralised bone and calcium phosphate scaffold was demonstrated.
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Affiliation(s)
- J O Eniwumide
- Department of Materials, Queen Mary University of London, London, UK
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44
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Mel PAL, Meijer GJ, Koole R, Cune MS. [Recovery of oral function following surgical treatment for an oral cavity cancer]. Ned Tijdschr Tandheelkd 2007; 114:349-52. [PMID: 17822244] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Ablative surgery for oral cancer results in loss or alterations of anatomical structures, which may impair oral functions, such as speech, mastication, and swallowing. Oral functions are impaired further by significant side-effects of additional postoperative radiation therapy. Improvement of oral functions may be achieved by implant-supported prosthetic rehabilitation. The recommended treatment is a 4-implants retained overdenture. A fixed 2 unit implant-supported partial denture seems a feasible alternative treatment.
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Affiliation(s)
- P A L Mel
- Zorgeenheid Mondziekten, Kaakchirurgie en Bijzondere Tandheelkunde, Divisie Heelkundige Specialismen van het Universitair Medisch Centrum Utrecht.
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45
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Kruizinga EHW, Meijer GJ, Koole R, van Es RJJ. [Arteriovenous malformation in the mandibula]. Ned Tijdschr Tandheelkd 2007; 114:300-3. [PMID: 17715775] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A 15-year-old autistic boy of subnormal intelligence appeared at the office of his dental practitioner complaining about pain in the third quadrant. Investigation revealed that the second molar could be intruded easily. No other irregularities, such as caries or periodontal disease were apparent. Due to the severe pain it was decided that the tooth should be extracted. Extraction of the tooth induced massive bleeding. Hemostasis was achieved by repositioning the molar in its alveolus, according to the principle of putting a cork in a bottle. Radiographic investigation showed the presence of an intraosseous arteriovenous malformation. These malformations are potentially life-threatening lesions. Treatment of choice is a combination of transarterial embolization and surgical removal of the malformation.
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Affiliation(s)
- E H W Kruizinga
- Uit de afdeling Mondziekten en Kaak- en Aangezichtschirurgie en Bijzondere Tandheelkunde van het Universitair Medisch Centrum Utrecht
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Meijer GJ, Mel P, Koole R, Cune MS. Fixed partial dentures on two implants: raising comfort in irradiated edentulous patients. Int J Oral Maxillofac Surg 2007; 36:646-8. [PMID: 17418533 DOI: 10.1016/j.ijom.2007.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 08/20/2006] [Revised: 01/02/2007] [Accepted: 02/02/2007] [Indexed: 11/25/2022]
Abstract
Surgical treatment of malignancies involving the oral cavity often results in an altered anatomical situation, which may severely hamper oral function. Postoperative radiotherapy resulting in reduced salivary secretion further worsens functions such as speech, chewing (mastication) and swallowing. In order to improve oral functioning, the use of dental implants was proposed. To reconstruct the edentulous mandible, especially in cases involving postoperative irradiation, implant-borne prosthetic construction on four permucosal implants has been advocated, but this treatment concept has some practical drawbacks. As the chewing force is reduced as a result of irradiation of the masticatory muscles, it is hypothesized that a fixed prosthetic construction on only two implants is a feasible alternative. Up until now 10 patients have been treated successfully according to this concept at the authors' clinic.
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Affiliation(s)
- G J Meijer
- Department of Oral & Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
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Meijer GJ, de Klerk J, Bzdusek K, Kaus MR. TH-E-M100F-02: CTV-To-PTV Margins for Prostate Irradiations, a Quantitative Assessment Using Novel Voxel Tracking Techniques. Med Phys 2007. [DOI: 10.1118/1.2761748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Raghoebar GM, Meijer GJ, Smeele LE. [Reconstruction of defects in the oral and maxillofacial region. A review of the various options for treatment]. Ned Tijdschr Tandheelkd 2007; 114:47-53. [PMID: 17274244] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Reconstructing defects of the oral cavity or face often poses a significant challenge to the surgeon. Defects of the oral and maxillofacial region can be closed with surgical techniques, with prosthetic constructions, or a combination of these techniques. Both defects of bone, soft tissue and teeth can be reconstructed with these techniques. The aim of reconstructing an oral or facial defect is to obtain optimal function and aesthetics which closely approximate the original form and function. Endosseous implants appear to be useful for retaining prosthetic constructions.
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Affiliation(s)
- G M Raghoebar
- Afdeling Kaakchirurgie van het Universitair Medisch Centrum Groningen.
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Topolnjak R, van der Heide UA, Meijer GJ, van Asselen B, Raaijmakers CPJ, Lagendijk JJW. Influence of the linac design on intensity-modulated radiotherapy of head-and-neck plans. Phys Med Biol 2006; 52:169-82. [PMID: 17183134 DOI: 10.1088/0031-9155/52/1/011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this study, we quantify the impact of linac/MLC design parameters on IMRT treatment plans. The investigated parameters were leaf width in the MLC, leaf transmission, related to the thickness of the leaves, and penumbra related primarily to the source size. Seven head-and-neck patients with stage T1-T3N0-N2cM0 oropharyngeal cancer were studied. For each patient nine plans were made with a different set of linac/MLC parameters. The plans were optimized in Pinnacle(3) v7.6c and PLATO RTS v2.6.4, ITP v1.1.8. A hypothetical ideal linac/MLC was introduced to investigate the influence of one parameter at a time without interaction of other parameters. When any of the three parameters was increased from the ideal set-up values (leaf width 2.5 mm, transmission 0%, penumbra 3 mm), the mean dose to the parotid glands increased, given the same tumour coverage. The largest increase was found for increasing leaf transmission. The investigation showed that by changing more than one parameter of the ideal linac/MLC set-up, the increase in the mean dose was smaller than the sum of dose increments for each parameter separately. As a reference to clinical practice, we also optimized the plans of the seven patients with the clinically used Elekta SLi 15, equipped with a standard MLC with a leaf width of 10 mm. As compared to the ideal linac, this resulted in an increase of the average dose to the parotid glands of 5.8 Gy.
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Affiliation(s)
- R Topolnjak
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Verhoeven JW, Cune MS, Meijer GJ. [(Pain) complaints that are "not understood" after implant surgery. Diagnosis with CT/DentaScan]. Ned Tijdschr Tandheelkd 2005; 112:99-102. [PMID: 15792394] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Combining clinical examination and panoramic, periapical or lateral cephalometric radiographs is generally sufficient in the pre- and post-operative investigation of most implant patients. Sometimes there is a need for more information needing computer tomography (CT) as an additional diagnostic tool. The obtained CT data can be manipulated and reconstructed with software programs such as DentaScan. The resulting cross sections, that can be given in true proportions, are perpendicular to the course of the jaw. Interpretation of these processed images is much easier but not always more accurate than the original scans. Pre-operatively, CT/DentaScans can be used not only for the determination of bone quantity and quality, but also for the location of relevant anatomical structures. Post-operatively, the scans can be valuable in the diagnosis of unexplained problems that may be related to the placed implants. Three case reports illustrate the use and indication of CT/DentaScans in solving implant related maxillary pathology or neuralgic pain.
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Affiliation(s)
- J W Verhoeven
- Afdeling Mondziekten, Kaakchirurgie en Bijzondere Tandheelkunde van het Universitair Medisch Centrum Utrecht.
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