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Sakkas A, Heil S, Kargus S, Rebel M, Mischkowski RA, Thiele OC. Tocilizumab: Another medication related to osteonecrosis of the jaws? A case report and literature review. GMS Interdiscip Plast Reconstr Surg DGPW 2021; 10:Doc03. [PMID: 33928006 PMCID: PMC8054499 DOI: 10.3205/iprs000153] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients receiving antiresorptive medication, such as bisphosphonates and denosumab, for different oncologic and non-oncologic diseases. Here, we report a case of MRONJ in a patient treated with tocilizumab, a humanized anti-interleukin-6 receptor antibody that effectively treats moderate to severe rheumatoid arthritis in adults. Case description: A 45-year-old female patient diagnosed with severe rheumatoid arthritis, who had been undergoing intravenous tocilizumab therapy for three years without history of bisphosphonate use, was referred to our department. Four weeks previously, several teeth in the maxilla and mandible were removed under local anesthesia by her dentist. Two weeks after the extractions, she felt pain in both jaws. We diagnosed wound dehiscence and delayed healing of the alveolar bone after the tooth extractions. Digital volume tomography showed persistent dry alveolar sockets. The patient underwent surgical debridement of necrotic bone, and intravenous antibiotics were administered in hospital. Five months later, wound dehiscence reoccurred in the same regions. Histopathological analysis of bone biopsies revealed a diagnosis of MRONJ. Four months later, wound dehiscence occurred in the left maxillary alveolar ridge, and local bone resection was performed under antibiotic treatment. Twenty-four months after the last surgery, wound dehiscence had healed completely without signs of recurrence. Discussion: Osteomyelitis of the jaw in patients treated with tocilizumab has not been reported often. This case confirms the potential role of this interleukin-6 receptor inhibitor in the pathogenesis of MRONJ and shows that patients who receive tocilizumab with MRONJ-like symptoms should be closely monitored. The pathomechanism of MRONJ under tocilizumab therapy remains unclear, so dental practitioners, maxillofacial surgeons, and rheumatologists should look for signs of MRONJ in patients receiving tocilizumab to prevent MRONJ onset.
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Affiliation(s)
- Andreas Sakkas
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Sebastian Heil
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Steffen Kargus
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Martin Rebel
- Department of Pathology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Robert A Mischkowski
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Oliver C Thiele
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
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Sakkas A, Nolte I, Heil S, Mayer B, Kargus S, Mischkowski RA, Thiele OC. Eggerthia catenaformis infection originating from a dental abscess causes severe intestinal complications and osteomyelitis of the jaw. GMS Interdiscip Plast Reconstr Surg DGPW 2021; 10:Doc02. [PMID: 33928005 PMCID: PMC8051610 DOI: 10.3205/iprs000152] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Odontogenic foci may result to generalized infections spreading the bacteria through contiguous anatomic cavities or hematogenous spread. The most reported secondary infections caused by oral pathogens are intracranial abscesses. Although, few reports in the literature describe the bacterial spread to extracranial locations. Case description: We describe the case of a 52-year-old male Caucasian patient who was admitted to our hospital suffering from severe sepsis caused by a submandibular abscess. Eggerthia catenaformis was detected in blood and abscess material (confirmed by MALDI-TOF mass spectrometry). The patient subsequently developed a perihepatic abscess and colon perforation, and was stabilized after several surgical interventions. He remained hospitalized for 66 days receiving intravenous antibiotics. Five months later, jaw osteonecrosis with Actinomyces contamination was detected in the left mandible, which also had to be treated surgically. Three years after the last surgery, no signs of recurrence have been detected. Discussion: Oral and maxillofacial surgeons should understand the characteristics of systemic infections, in which the potentially causal intraoral odontogenic foci often lack acute symptoms. If other origins of infection are not detected, elimination of the potentially causal odontogenic foci should be performed. However, the decision making criteria to eliminate suspected causal teeth is needed to be elucidated through more studies.
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Affiliation(s)
- Andreas Sakkas
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Isabel Nolte
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Sebastian Heil
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Boris Mayer
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Steffen Kargus
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Robert A Mischkowski
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Oliver C Thiele
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
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Thiele OC, Nolte IM, Mischkowski RA, Safi AF, Perrin J, Zinser M, Zöller JE, Kreppel M. Craniomaxillofacial patient-specific CAD/CAM implants based on cone-beam tomography data - A feasibility study. J Craniomaxillofac Surg 2018; 46:1461-1464. [PMID: 29958732 DOI: 10.1016/j.jcms.2018.05.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/27/2018] [Accepted: 05/30/2018] [Indexed: 12/22/2022] Open
Abstract
Customized implants have simplified surgical procedures and have improved patient outcome in craniomaxillofacial surgery. Traditionally, patient-specific data is gathered by conventional computed tomography (CT). However, cone-beam CT (CBCT) can generate a 3D reconstruction of the area of interest with a lower dose of radiation at reduced cost. In this study, we investigated the feasibility of using CBCT data to design and generate customized implants for patients requiring craniomaxillofacial reconstruction. We used CBCT to generate 62 implants for 51 consecutive patients admitted to our department between January 2015 and December 2017. The indications for reconstruction and types of reconstruction were very variable. In all cases, the implants were well fitted and no implant-related complications were detected. Pre-surgical planning was faster and more efficient as we did not have to consult a radiologist. Although CBCT data is more difficult to process than conventional CT data for the implant provider, the clinical advantages are pronounced and we now use CBCT as standard in our department. In conclusion, we have shown that using CBCT to design and manufacture customized implants for reconstruction of the craniomaxillofacial area is feasible and recommend this approach to other departments.
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Affiliation(s)
- Oliver C Thiele
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, (Head: Prof. R. A. Mischkowski, MD, DDS), Ludwigshafen, Germany.
| | - Isabel M Nolte
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, (Head: Prof. R. A. Mischkowski, MD, DDS), Ludwigshafen, Germany
| | - Robert A Mischkowski
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, (Head: Prof. R. A. Mischkowski, MD, DDS), Ludwigshafen, Germany
| | - Ali F Safi
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital Cologne, (Head: Prof. J. E. Zöller, MD, DDS), Cologne, Germany
| | - Jason Perrin
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, (Head: Prof. D. Hänggi, MD), Mannheim, Germany
| | - Max Zinser
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital Cologne, (Head: Prof. J. E. Zöller, MD, DDS), Cologne, Germany
| | - Joachim E Zöller
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital Cologne, (Head: Prof. J. E. Zöller, MD, DDS), Cologne, Germany
| | - Matthias Kreppel
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital Cologne, (Head: Prof. J. E. Zöller, MD, DDS), Cologne, Germany
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Thiele OC, Kreppel M, Dunsche A, Eckardt AM, Ehrenfeld M, Fleiner B, Gaßling V, Gehrke G, Gerressen M, Gosau M, Gröbe A, Haßfeld S, Heiland M, Hoffmeister B, Hölzle F, Klein C, Krüger M, Kübler AC, Kübler NR, Kuttenberger JJ, Landes C, Lauer G, Martini M, Merholz ET, Mischkowski RA, Al- Nawas B, Nkenke E, Piesold JU, Pradel W, Rasse M, Rachwalski M, Reich RH, Rothamel D, Rustemeyer J, Scheer M, Schliephake H, Schmelzeisen R, Schramm A, Schupp W, Spitzer WJ, Stocker E, Stoll C, Terheyden H, Voigt A, Wagner W, Weingart D, Werkmeister R, Wiltfang J, Ziegler CM, Zöller JE. Current concepts in cleft care: A multicenter analysis. J Craniomaxillofac Surg 2018. [DOI: 10.1016/j.jcms.2018.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sundermann BV, Uhlmann L, Hoffmann J, Freier K, Thiele OC. The localization and risk factors of squamous cell carcinoma in the oral cavity: A retrospective study of 1501 cases. J Craniomaxillofac Surg 2017; 46:177-182. [PMID: 29242026 DOI: 10.1016/j.jcms.2017.10.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 06/20/2017] [Revised: 09/20/2017] [Accepted: 10/23/2017] [Indexed: 01/08/2023] Open
Abstract
Head and neck cancer is the tenth leading cause of cancer mortality. Ninety percent of tumours in the oral cavity are squamous cell carcinomas. Information about the exact localisation of OSCC is missing in the literature. In the present study, we retrospectively analysed a total of 1501 OSCC patients, who were treated between 1975 and 2009. The purpose of this study was to examine the localisation of OSCC tumours and to analyse the influence of various parameters on tumour localisation. 71.5% of these patients were male and 28.5% were female. The mean age was 60 years. The most common sites of OSCC occurrence were the floor of the mouth and the anterior base of the mouth. The hard palate was the most affected anatomical area of the maxilla. Descriptive statistical analysis, chi-square testing and a multivariate analysis using a multinomial logistical model showed a significant correlation of younger age and female gender with tumour occurrence in the maxilla and the tongue. We provide a very detailed anatomical mapping of OSCC.
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Affiliation(s)
- Britta V Sundermann
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Hoffmann, MD, DDS), University Hospital Heidelberg, Germany.
| | - Lorenz Uhlmann
- Department of Medical Biometry and Informatics (Head: Prof. M. Kieser MD), Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Hoffmann, MD, DDS), University Hospital Heidelberg, Germany
| | - Kolja Freier
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Hoffmann, MD, DDS), University Hospital Heidelberg, Germany
| | - Oliver C Thiele
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Hoffmann, MD, DDS), University Hospital Heidelberg, Germany
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Thiele OC, Kreppel M, Bittermann G, Bonitz L, Desmedt M, Dittes C, Dörre A, Dunsche A, Eckert AW, Ehrenfeld M, Fleiner B, Frerich B, Gaggl A, Gerressen M, Gmelin L, Hammacher A, Haßfeld S, Heiland M, Hemprich A, Hidding J, Hölzle F, Howaldt HP, Iizuka T, Kater W, Klein C, Klein M, Köhnke RH, Kolk A, Kübler AC, Kübler NR, Kunkel M, Kuttenberger JJ, Kreusch T, Landes C, Lehner B, Mischkowski RA, Mokros S, Neff A, Nkenke E, Palm F, Paulus GW, Piesold JU, Rasse M, Rodemer H, Rothamel D, Rustemeyer J, Sader R, Scheer M, Scheffler B, Schippers C, Schliephake H, Schmelzeisen R, Schramm A, Spitzer WJ, Stoll C, Terheyden H, Weingart D, Wiltfang J, Wolff KD, Ziegler CM, Zöller JE. Moving the mandible in orthognathic surgery - A multicenter analysis. J Craniomaxillofac Surg 2016; 44:579-83. [PMID: 27017103 DOI: 10.1016/j.jcms.2016.01.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 07/20/2015] [Revised: 01/11/2016] [Accepted: 01/27/2016] [Indexed: 11/30/2022] Open
Abstract
Orthognathic surgery has always been a classical focus of maxillofacial surgery. Since more than 100 years, various surgical techniques for mandibular repositioning have been developed and clinically tested. Since the establishment of plate and screw osteosynthesis, orthognathic surgery became more stable and safe. Nowadays, different surgical methods for mobilising the mandible are existing. This international multicenter analysis (n = 51 hospitals) is providing first evidence based data for the current use of different surgical methods. The dominating techniques were Obwegeser/dal Pont (61%) followed by Hunsuck/Epker (37%) and Perthes/Schlössmann (29%). The main osteosynthesis materials were plates (82%), bicortical screws (23.5%), or a combination of both (5.9%). 47% of all centers reported to use several surgical methods at the same time, depending on the anatomical problem and the surgeon's preference. This shows that different surgical methods seem to work as comparable, safe, and reliable procedures in everydays clinical practise. On this basis, further prospective studies could evaluate possible advantages for our patients.
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Affiliation(s)
- Oliver C Thiele
- Department of Oral, Maxillofacial and Facial Plastic Surgery (Head: Prof. R. A. Mischkowski), Ludwigshafen Hospital, Germany.
| | - Matthias Kreppel
- Department of Craniomaxillofacial and Plastic Surgery (Head: Prof. J.E. Zöller), University of Cologne, Germany
| | - Gido Bittermann
- Department of Oral and Maxillofacial Surgery (Head: Prof. R. Schmelzeisen), University Medical Center Freiburg, Germany
| | - Lars Bonitz
- Department of Craniomaxillofacial Surgery - Plastic Surgery (Head: Prof. S. Haßfeld), University Witten/Herdecke, Hospital Dortmund, Germany
| | - Maria Desmedt
- Fachklinik Hornheide, Department of Cranio-Maxillofacial Surgery (Head: Prof. M. Klein), Münster, Germany
| | - Carsten Dittes
- Department of Oral and Maxillofacial Surgery (Head: C. Dittes), Dietrich-Bonhoeffer-Hospital, Neubrandenburg, Germany
| | - Annegret Dörre
- Department of Oral and Maxillofacial Surgery (Head: A. Dörre), Chemnitz Hospital, Germany
| | - Anton Dunsche
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Dunsche), City Hospital Karlsruhe, Germany
| | - Alexander W Eckert
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery (Head: Prof. A. Eckert), Martin-Luther-University Halle-Wittenberg, Germany
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery (Head: Prof. M. Ehrenfeld), Ludwig Maximilians University of Munich, Germany
| | - Bernd Fleiner
- Oral and Maxillofacial Surgery (Head: B. Fleiner), Im Pferseepark, Augsburg, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Surgery (Head: Prof. B. Frerich), Facial Plastic Surgery, Rostock University Medical Center, Germany
| | - Alexander Gaggl
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Gaggl), Paracelsus Medical University Salzburg, Austria
| | - Marcus Gerressen
- Department of Oral, Maxillofacial and Plastic Facial Surgery (Head: PD M. Gerressen), Heinrich-Braun Hospital Zwickau, Germany
| | - Leonore Gmelin
- Department of Oral, Maxillofacial and Facial Plastic Surgery (Head: Prof. R. A. Mischkowski), Ludwigshafen Hospital, Germany
| | - Andreas Hammacher
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Hammacher and H. Sieber), Malteser Hospital St. Johannes, Duisburg, Germany
| | - Stefan Haßfeld
- Department of Craniomaxillofacial Surgery - Plastic Surgery (Head: Prof. S. Haßfeld), University Witten/Herdecke, Hospital Dortmund, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery (Head: Prof. M. Heiland), University Medical Center Hamburg-Eppendorf, Germany
| | - Alexander Hemprich
- Department of Oral and Maxillofacial Plastic Surgery (Head: Prof. A. Hemprich), Leipzig University, Germany
| | - Johannes Hidding
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Hidding), Bethesda Hospital Mönchengladbach, Germany
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Plastic Facial Surgery (Head: Prof. F. Hölzle), RWTH Aachen University Hospital, Germany
| | - Hans-Peter Howaldt
- Department for Cranio-Maxillofacial Surgery, Plastic Surgery (Head: Prof. H.P. Howaldt), University Hospital Giessen, Germany
| | - Tateyuki Iizuka
- Department of Cranio-Maxillofacial Surgery (Head: Prof. T. Iizuka), Inselspital, Bern University Hospital, Switzerland
| | - Wolfgang Kater
- Department of Oral and Maxillofacial Surgery (Head: W. Kater), Hochtaunus Hospital Bad Homburg, Germany
| | - Cornelius Klein
- Department of Oral and Maxillofacial Surgery (Head: Prof. C. Klein), Donauisar Hospital Deggendorf, Germany
| | - Martin Klein
- Fachklinik Hornheide, Department of Cranio-Maxillofacial Surgery (Head: Prof. M. Klein), Münster, Germany
| | - Robert H Köhnke
- Department of Oral and Maxillofacial Surgery (Head: Prof. M. Heiland), University Medical Center Hamburg-Eppendorf, Germany
| | - Andreas Kolk
- Department of Oral and Cranio-Maxillofacial Surgery (Head: Prof. K.D. Wolff), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander C Kübler
- Department of Oral and Maxillofacial Plastic Surgery (Head: Prof. A.C. Kübler), University of Würzburg, Germany
| | - Norbert R Kübler
- Department of Cranio- and Maxillofacial Surgery (Head: Prof. N.R. Kübler), Heinrich-Heine-University Düsseldorf, Germany
| | - Martin Kunkel
- Department of Oral and Plastic Maxillofacial Surgery (Head: Prof. M. Kunkel), Ruhr-University Bochum, Germany
| | - Johannes J Kuttenberger
- Department of Oral and Maxillofacial Surgery (Head: PD J. Kuttenberger), Luzerner Kantonsspital, Switzerland
| | - Thomas Kreusch
- Department of Oral and Maxillofacial Plastic Surgery (Head: Prof. T. Kreusch), Asklepios Hospital Nord, Hamburg, Germany
| | - Constantin Landes
- Department of Oral and Maxillofacial Surgery (Head: Prof. C. Landes), Sana Hospital Offenbach, Germany
| | - Bernhard Lehner
- Department of Oral and Maxillofacial Surgery (Head: B. Lehner), Health Center St. Marien, Hospital Amberg, Germany
| | - Robert A Mischkowski
- Department of Oral, Maxillofacial and Facial Plastic Surgery (Head: Prof. R. A. Mischkowski), Ludwigshafen Hospital, Germany
| | - Steffen Mokros
- Department of Oral and Maxillofacial Surgery (Head: S. Mokros), Ameos Hospital Halberstadt, Germany
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Neff), University of Marburg, University Hospital Giessen and Marburg, Campus Marburg, Germany
| | - Emeka Nkenke
- Department of Oral and Maxillofacial Surgery (Head: Prof. E. Nkenke), Medical University of Vienna, Austria
| | - Frank Palm
- Department of Oral and Maxillofacial Surgery (Head: Prof. F. Palm), Hospital Konstanz, Germany
| | - Gerhard W Paulus
- Department of Oral and Maxillofacial Surgery (Head: Prof. G.W. Paulus), Paracelsus Hospital Munich, Germany
| | - Jörn U Piesold
- Department of Oral and Maxillofacial Surgery (Head: PD J.U. Piesold), Helios Hospital Erfurt, Germany
| | - Michael Rasse
- Department for Cranio-, Maxillofacial and Oral Surgery (Head: Prof. M. Rasse), Medical University Innsbruck, Austria
| | - Herbert Rodemer
- Department of Oral and Maxillofacial Surgery (Head: H. Rodemer), Saarbrücken Hospital, Germany
| | - Daniel Rothamel
- Department of Craniomaxillofacial and Plastic Surgery (Head: Prof. J.E. Zöller), University of Cologne, Germany
| | - Jan Rustemeyer
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Rustemeyer), Plastic Operations, Hospital Bremen, Germany
| | - Robert Sader
- Department of Oral, Maxillofacial and Plastic Facial Surgery (Head: Prof. R. Sader), University Medical Centre Frankfurt/Main, Germany
| | - Martin Scheer
- Department of Oral and Maxillofacial Surgery (Head: PD M. Scheer), Hospital Minden, Germany
| | - Birgit Scheffler
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery (Head: Prof. A. Eckert), Martin-Luther-University Halle-Wittenberg, Germany
| | - Christian Schippers
- Department of Oral and Maxillofacial Surgery (Head: Prof. C. Schippers), Agaplesion Diakonie Hospital Rotenburg (Wümme), Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery (Head: Prof. H. Schliephake), George-Augusta-University, Göttingen, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery (Head: Prof. R. Schmelzeisen), University Medical Center Freiburg, Germany
| | - Alexander Schramm
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Schramm), Facial Plastic Surgery, Military Hospital of Ulm and University Hospital Ulm, Germany
| | - Wolfgang J Spitzer
- Department for Oral and Maxillofacial Surgery (Head: Prof. W. Spitzer), University Clinic of Saarland, Homburg/Saar, Germany
| | - Christian Stoll
- Department of Oral and Maxillofacial Surgery (Head: Prof. C. Stoll), Ruppiner Kliniken, Neuruppin, Germany
| | - Hendrik Terheyden
- Department of Oral and Maxillofacial Surgery (Head: Prof. H. Terheyden), Red Cross Hospital, Kassel, Germany
| | - Dieter Weingart
- Department of Oral and Maxillofacial Surgery (Head: Prof. D. Weingart), Katharinen Hospital, Stuttgart, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Wiltfang), University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Klaus D Wolff
- Department of Oral and Cranio-Maxillofacial Surgery (Head: Prof. K.D. Wolff), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christoph M Ziegler
- Department of Oral and Maxillofacial Surgery (Head: Prof. C. Ziegler), St Olavs University Hospital, Norwegian University for Science and Technology, Trondheim, Norway
| | - Joachim E Zöller
- Department of Craniomaxillofacial and Plastic Surgery (Head: Prof. J.E. Zöller), University of Cologne, Germany
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Seeberger R, Asi Y, Thiele OC, Hoffmann J, Stucke K, Engel M. Neurosensory alterations and function of the temporomandibular joint after high oblique sagittal split osteotomy: an alternative technique in orthognathic surgery. Br J Oral Maxillofac Surg 2013; 51:536-40. [DOI: 10.1016/j.bjoms.2012.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
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Thiele OC, Mertens C, Bacon C, Flechtenmacher C, Zaoui K, Mischkowski RA. Facial basal cell carcinoma with successive metastases to the neck, thyroid gland and lung. J Craniomaxillofac Surg 2013; 42:489-91. [PMID: 23849247 DOI: 10.1016/j.jcms.2013.06.007] [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: 01/16/2013] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 11/30/2022] Open
Abstract
Basal cell carcinoma of the skin is the most common malignancy in the head and neck area. Regional and distant metastases rarely occur with this type of tumour. We report an uncommon case of a sclerodermiform basal cell carcinoma of the facial skin in which metastases developed several years after the primary tumour. The metastases occurred in the soft tissue of the neck, the thyroid gland and the lung. This is the first case of BCC with triple metastases which were histologically confirmed.
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Affiliation(s)
- Oliver C Thiele
- Department of Oral, Maxillofacial and Facial Plastic Surgery (Head: Prof. Robert Mischkowski), Ludwigshafen Hospital, Bremserstrasse 79, 67063 Ludwigshafen am Rhein, Germany.
| | - Christian Mertens
- Department of Oral and Maxillofacial Surgery (Head: Prof. Jürgen Hoffmann), University Hospital Heidelberg, INF 400, Heidelberg, Germany
| | - Claire Bacon
- Department of Human Genetics (Head: Prof. Gudrun Rappold), Molecular Genetics Division, University Hospital Heidelberg, INF 366, Heidelberg, Germany
| | - Christa Flechtenmacher
- Institute of Pathology (Head: Prof. Peter Schirmacher), University Hospital Heidelberg, INF 224, Heidelberg, Germany
| | - Karim Zaoui
- Department of Otolaryngology, Head and Neck Surgery (Head: Prof. Peter Plinkert), University Hospital Heidelberg, INF 400, Heidelberg, Germany
| | - Robert A Mischkowski
- Department of Oral, Maxillofacial and Facial Plastic Surgery (Head: Prof. Robert Mischkowski), Ludwigshafen Hospital, Bremserstrasse 79, 67063 Ludwigshafen am Rhein, Germany
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Seeberger R, Thiele OC, Mertens C, Hoffmann J, Engel M. Proximal segment positioning with high oblique sagittal split osteotomy: indications and limits of intraoperative mobile cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:731-6. [DOI: 10.1016/j.oooo.2012.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
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Reuschenbach M, Kansy K, Garbe K, Vinokurova S, Flechtenmacher C, Toth C, Prigge ES, Thiele OC, Reinert S, Hoffmann J, von Knebel Doeberitz M, Freier K. Lack of evidence of human papillomavirus-induced squamous cell carcinomas of the oral cavity in southern Germany. Oral Oncol 2013; 49:937-942. [PMID: 23608471 DOI: 10.1016/j.oraloncology.2013.03.451] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 02/13/2013] [Revised: 03/19/2013] [Accepted: 03/24/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of the present study was to identify HPV-attributable SCC of the oral cavity (OSCC) in a cohort of patients from southern Germany. MATERIALS AND METHODS A sensitive PCR-enzyme immunoassay (EIA) was followed by a more specific in situ hybridization (ISH) to detect high risk human papillomavirus (HPV). An immunohistochemical dual-staining for p16(INK4a) and the proliferation marker Ki-67 was used to assess whether co-expression of p16(INK4a)/Ki-67 is a better surrogate marker for HPV in OSCC than p16(INK4a) alone, based on the hypothesis that combined p16(INK4a) and Ki-67 expression might specifically discriminate oncogene-induced p16(INK4a) expression from cell-cycle arrest-inducing senescence-associated p16(INK4a) expression. RESULTS HPV-DNA by PCR-EIA could be detected in 25.1% (69/275) of the tumors, but ISH was negative in all of them. Diffuse p16(INK4a) overexpression was detected in 11 HPV PCR-positive tumors, but also in 6 HPV PCR-negative tumors. p16(INK4a)-expressing cells in diffusely positive tumors co-expressed Ki-67, irrespective of the HPV status. Neither the sole HPV status nor combined HPV/p16(INK4a) status nor the sole p16(INK4a) status was significantly associated with disease free or overall survival, however a trend towards better overall survival of patients whose tumor expressed p16(INK4a) in a focal pattern (=p16(INK4a)-positive/Ki-67-negative cells) compared to no p16(INK4a) expression (p=0.09) was observed. CONCLUSION Viral DNA can be detected in some tumors by a sensitive PCR, but absence of ISH signals indicates that the HPV-attributable fraction is smaller than estimated from PCR positivity. p16(INK4a)/Ki-67 co-expression is detectable in a fraction of OSCC irrespective of the HPV status.
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Affiliation(s)
- Miriam Reuschenbach
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany; Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany.
| | - Katinka Kansy
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Kira Garbe
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany; Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Svetlana Vinokurova
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany; Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Christa Flechtenmacher
- Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT) Tissue Bank, Im Neuenheimer Feld 221, 69120 Heidelberg, Germany
| | - Csaba Toth
- Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT) Tissue Bank, Im Neuenheimer Feld 221, 69120 Heidelberg, Germany
| | - Elena-Sophie Prigge
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany; Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Oliver C Thiele
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, University of Tübingen, Osianderstr. 2, 72076 Tübingen, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany; Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Kolja Freier
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Thiele OC, Seeberger R, Engel M, Freier K, Hoffmann J. Development of the clinical use of distant flaps for head and neck reconstruction. J Craniomaxillofac Surg 2013; 42:79-83. [PMID: 23522831 DOI: 10.1016/j.jcms.2013.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 11/19/2012] [Revised: 02/20/2013] [Accepted: 02/21/2013] [Indexed: 11/29/2022] Open
Abstract
The reconstruction of hard and soft tissue defects, mainly after ablative oncologic surgery in the head and neck area, is an evolving field. The use of free flaps for reconstruction of the head and neck is considered to be the surgical standard. In our analysis of more than 1000 free flaps we give an overview of the development of the use of different types of free tissue transfer to the head and neck area over the last 25 years. We show that the evolving field of head and neck reconstruction raises new possibilities with new types of flaps, whereas other types of flaps disappear in the everyday clinical use. The spectrum of reconstruction possibilities broadens with the number of different flap types available to the head and neck surgeon.
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Affiliation(s)
- Oliver C Thiele
- Department of Oral and Maxillofacial Surgery (Head: Prof. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany.
| | - Robin Seeberger
- Department of Oral and Maxillofacial Surgery (Head: Prof. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery (Head: Prof. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Kolja Freier
- Department of Oral and Maxillofacial Surgery (Head: Prof. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery (Head: Prof. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany
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Scherfler S, Freier K, Seeberger R, Bacon C, Hoffmann J, Thiele OC. Cranio-maxillofacial non-Hodgkin's lymphoma: clinical and histological presentation. J Craniomaxillofac Surg 2011; 40:e211-3. [PMID: 22093243 DOI: 10.1016/j.jcms.2011.10.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 12/18/2022] Open
Abstract
Non-Hodgkin's lymphoma represents about 5% of all malignant lesions of the head and neck. In this study we retrospectively evaluated clinical presentation, histological subtype and long-term prognosis of 42 patients with non-Hodgkin's lymphoma involving the craniofacial area. The mean age at diagnosis was 64 years. More than half of the patients presented with disseminated disease at multiple sites (55%, n=23). In 62% (n=26) the first manifestation was extranodal. The most common affected region was the oral cavity (65%, n=17). Treatment consisted of local therapy, including surgical resection and radiation, as well as chemotherapy with or without local therapy. Recurrence occurred in 31% (n=13) of the treated patients. Mean survival after first diagnosis varied from 17 months in patients presenting with diffuse large B-cell lymphoma (DLBCL), to 8.5 years in patients with follicular lymphoma. The most common histological subtype is DLBCL. Standard treatment for DLBCL consists of chemotherapy combined with CD 20 monoclonal antibody, even after total resection of the tumour. There is high risk of systemic disease in patients presenting with non-Hodgkin's lymphoma and high risk of post therapy recurrence.
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Affiliation(s)
- Sebastian Scherfler
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
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Thiele OC, Seeberger R, Flechtenmacher C, Hofele C, Freier K. The role of elective supraomohyoidal neck dissection in the treatment of early, node-negative oral squamous cell carcinoma (OSCC): a retrospective analysis of 122 cases. J Craniomaxillofac Surg 2011; 40:67-70. [PMID: 21393009 DOI: 10.1016/j.jcms.2011.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [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: 05/21/2010] [Revised: 12/17/2010] [Accepted: 02/08/2011] [Indexed: 11/20/2022] Open
Abstract
The adequate treatment of the neck in early, clinically node-negative oral squamous cell carcinoma (OSCC) remains controversial. To assess whether elective supraomohyoid neck dissection is reasonable and efficient in early, locally circumscribed OSCC, the outcomes of treatment of 122 patients with an OSCC of clinical UICC stage I or II were retrospectively analysed in this study. Occult lymph node metastases were detected in 13.9% (17/122) of cases. They were more frequently found in T2 compared to T1 tumours (19.7% (14/71) vs. 5.9% (3/51), p=0.03), age, gender and grading had no influence on the prevalence of occult lymph node metastases (all p-values>0.05) in a multivariate logistic regression model. Subsequent multivariate survival analysis found that the presence of occult metastases was an independent predictor of reduced disease-free survival after 5 years (82.2% vs. 62.5%, p=0.004, and 61.9% vs. 17.8%, p<0.001, respectively). Elective supraomohyoid neck dissection detects occult metastases in early, node-negative OSCC, and patients with early OSCC exhibiting occult metastases should be considered as high risk patients, warranting additional therapeutic regimes.
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Affiliation(s)
- Oliver C Thiele
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany.
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Seeberger R, Kater W, Schulte-Geers M, Thiele OC, Davids R, Hofele CH, Freier K. [Surgically assisted rapid maxillary expansion. Effects on the nasal airways and nasal septum]. HNO 2011; 58:806-11. [PMID: 20596681 DOI: 10.1007/s00106-010-2152-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgically assisted rapid maxillary expansion (SARME) is a standardized method to treat cross bites in maxillofacial surgery. Changes to the nasal airways are assumed due to the anatomic dependence between the palate and the nasal floor. PATIENTS AND METHODS In this study 19 patients with a transverse deficit of the upper jaw underwent SARME. CT scans were performed 1 month pre- and 6 months postoperatively. Effects to the lower nasal airways, the nasal septum and the hard palate were subsequently evaluated. RESULTS The mean distraction width of the upper jaws was 5.84 mm (SD 2.19) postoperatively. In addition to the dentoalveolar gain in width, a significant increase in the nasal floor was observed (p<0.001). The anterior part of the nasal floor was increased by 14.11%. An anterior-caudal tilt of the upper jaw was observed in the anterior part measuring 1.5 mm (SD 1.05). No significant deviation of the nasal septum occurred. CONCLUSION SARME has a significant effect on ear, nose and throat medicine. Nasal airways enlarge significantly, while no significant deviation of the nasal septum is observed.
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Affiliation(s)
- R Seeberger
- Klinik- und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitäts-Kopfklinik Heidelberg, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
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Thiele OC, Freier K, Bacon C, Flechtenmacher C, Scherfler S, Seeberger R. Craniofacial metastases: a 20-year survey. J Craniomaxillofac Surg 2010; 39:135-7. [PMID: 21044848 DOI: 10.1016/j.jcms.2010.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 06/21/2010] [Accepted: 10/04/2010] [Indexed: 11/17/2022] Open
Abstract
In this study we analysed the long-term prognosis of 52 patients with distant metastases to the craniofacial area. All patients were treated in our department between 1989 and 2009. Possible predictive factors for the overall survival prognosis like age, gender, histopathological type of the metastasis, location and tissue structure of the area in the head and neck region, time between primary tumour and metastasis and the therapy were evaluated. 62% of the patients with distant metastases in the craniofacial area were male (32/52), the average age was 63 years. Adenocarcinoma was the most common histological type (20/52) and lung (12/52), malignant melanoma of the skin (9/52) and breast (8/52) the most common primary tumour site. In 35% of all patients, the primary tumour was not known at the time of the diagnosis of the craniofacial metastasis, this number reduced to 17% without the patients with a CUP syndrome. Patients survived an average of 14.4 months after manifestation of the metastases and 43.4 months after the manifestation of the primary tumour.
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Affiliation(s)
- Oliver C Thiele
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany.
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Thiele OC, Freier K, Flechtenmacher C, Rohde S, Hofele C, Mühling J, Seeberger R. Haemangiopericytoma of the mandible. J Craniomaxillofac Surg 2010; 38:597-600. [PMID: 20199869 DOI: 10.1016/j.jcms.2010.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 01/27/2010] [Accepted: 01/29/2010] [Indexed: 11/25/2022] Open
Abstract
Haemangiopericytomas (HPCs) found in bony structures are rare sarcomas of vascular origin. Here, we report the case of a 41-year-old female with a HPC originating in the right ramus of the mandible. After tumour staging and biopsy for histological reference the tumour was surgically removed. The surgical technique is described and therapy options of these rare cases are discussed and compared with these cases already documented. To the best of our knowledge, this is the 6th case of mandibular HPC reported in the literature.
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Affiliation(s)
- Oliver C Thiele
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany.
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Thiele OC, Freier K, Bacon C, Egerer G, Hofele CM. Interdisciplinary combined treatment of craniofacial osteosarcoma with neoadjuvant and adjuvant chemotherapy and excision of the tumour: a retrospective study. Br J Oral Maxillofac Surg 2008; 46:533-6. [DOI: 10.1016/j.bjoms.2008.03.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2008] [Indexed: 10/22/2022]
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Thiele OC, Scuto I, Allamprese F, Freier K, Hoepner C, Simon R. Intermediate short-term tourniquet use during the preparation of a free vascularised fibula flap for mandibular reconstruction. A case report. Minerva Stomatol 2008; 57:53-57. [PMID: 18427371] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
First described by Taylor et al. in 1975, the fibula flap is well established as a universal method for reconstruction of defects in several medical fields. Mostly a tourniquet is kept on during the whole procedure of harvesting the fibula flap. In some hospitals the operation is performed without tourniquet. The outcome is mostly described as successful, but functional impairment and donor site morbidity should not be neglected and severe complications are not frequently reported. In this article we describe a modification of the standard harvesting techniques to minimise the ischaemia time of the flap as well as the danger of severe blood loss. The tourniquet was only activated during the final disconnection of the fibular artery and was released immediately after the successful harvesting of the fibula flap. This method combines the safety of a tourniquet during the critical disconnection procedure and the advantages of a long perfusion of the donor site and the graft.
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Affiliation(s)
- O C Thiele
- Department of Oral and Maxillofacial Surgery, University Hospital, Heidelberg, Germany
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Abstract
We investigated several factors which affect the stability of cortical screws in osteoporotic bone using 18 femora from cadavers of women aged between 45 and 96 years (mean 76). We performed bone densitometry to measure the bone mineral density of the cortical and cancellous bone of the shaft and head of the femur, respectively. The thickness and overall bone mass of the cortical layer of the shaft of the femur were measured using a microCT scanner. The force required to pull-out a 3.5 mm titanium cortical bone screw was determined after standardised insertion into specimens of the cortex of the femoral shaft. A significant correlation was found between the pull-out strength and the overall bone mass of the cortical layer (r2 = 0.867, p < 0.01) and also between its thickness (r2 = 0.826, p < 0.01) and bone mineral density (r2 = 0.861, p < 0.01). There was no statistically significant correlation between the age of the donor and the pull-out force (p = 0.246), the cortical thickness (p = 0.199), the bone mineral density (p = 0.697) or the level of osteoporosis (p = 0.378). We conclude that the overall bone mass, the thickness and the bone mineral density of the cortical layer, are the main factors which affect the stability of a screw in human female osteoporotic cortical bone.
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Affiliation(s)
- O C Thiele
- AO Research Institute, Clavadelerstrasse CH-7270, Davos Platz, Switzerland.
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