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Weber A, Enderle-Ammour K, Kurowski K, Metzger MC, Poxleitner P, Werner M, Rothweiler R, Beck J, Straehle J, Schmelzeisen R, Steybe D, Bronsert P. AI-Based Detection of Oral Squamous Cell Carcinoma with Raman Histology. Cancers (Basel) 2024; 16:689. [PMID: 38398080 PMCID: PMC10886627 DOI: 10.3390/cancers16040689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Stimulated Raman Histology (SRH) employs the stimulated Raman scattering (SRS) of photons at biomolecules in tissue samples to generate histological images. Subsequent pathological analysis allows for an intraoperative evaluation without the need for sectioning and staining. The objective of this study was to investigate a deep learning-based classification of oral squamous cell carcinoma (OSCC) and the sub-classification of non-malignant tissue types, as well as to compare the performances of the classifier between SRS and SRH images. Raman shifts were measured at wavenumbers k1 = 2845 cm-1 and k2 = 2930 cm-1. SRS images were transformed into SRH images resembling traditional H&E-stained frozen sections. The annotation of 6 tissue types was performed on images obtained from 80 tissue samples from eight OSCC patients. A VGG19-based convolutional neural network was then trained on 64 SRS images (and corresponding SRH images) and tested on 16. A balanced accuracy of 0.90 (0.87 for SRH images) and F1-scores of 0.91 (0.91 for SRH) for stroma, 0.98 (0.96 for SRH) for adipose tissue, 0.90 (0.87 for SRH) for squamous epithelium, 0.92 (0.76 for SRH) for muscle, 0.87 (0.90 for SRH) for glandular tissue, and 0.88 (0.87 for SRH) for tumor were achieved. The results of this study demonstrate the suitability of deep learning for the intraoperative identification of tissue types directly on SRS and SRH images.
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Affiliation(s)
- Andreas Weber
- Institute for Surgical Pathology, Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany
| | - Kathrin Enderle-Ammour
- Institute for Surgical Pathology, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Konrad Kurowski
- Institute for Surgical Pathology, Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Tumorbank Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Core Facility for Histopathology and Digital Pathology, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Marc C. Metzger
- Department of Oral and Maxillofacial Surgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, 79106 Freiburg, Germany
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, 80337 Munich, Germany
| | - Martin Werner
- Institute for Surgical Pathology, Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Tumorbank Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - René Rothweiler
- Department of Oral and Maxillofacial Surgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Jürgen Beck
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, 79106 Freiburg, Germany
- Department of Neurosurgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Jakob Straehle
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, 79106 Freiburg, Germany
- Department of Neurosurgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, 79106 Freiburg, Germany
| | - David Steybe
- Department of Oral and Maxillofacial Surgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, 79106 Freiburg, Germany
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, 80337 Munich, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Tumorbank Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Core Facility for Histopathology and Digital Pathology, Medical Center, University of Freiburg, 79106 Freiburg, Germany
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Abdullah A, Wuersching SN, Kollmuss M, Poxleitner P, Dewenter I, Brandenburg LS, Steybe D, Fegg FN, Smolka W, Otto S, Obermeier KT. X-Linked Hypophosphatemia: Does Targeted Therapy Modify Dental Impairment? J Clin Med 2023; 12:7546. [PMID: 38137614 PMCID: PMC10744150 DOI: 10.3390/jcm12247546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/22/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
X-linked hypophosphatemia is a rare, hereditary disorder that significant influences teeth and alveolar bone. The first clinical sign leading to the diagnosis of X-linked hypophosphatemia is often dental impairment with dental abscesses and dentin mineralization defects. Genetic analysis helped find the responsible gene and therefore opened up new ways of therapeutically managing X-linked hypophosphatemia. The human monoclonal antibody Burosumab represents a milestone in the targeted therapy of this hereditary disease by directly addressing its pathophysiology. Targeted therapy has been shown to improve skeletal impairment, pain, and phosphate metabolism. However, the influence of this new therapy on dental impairment has only been addressed in a few recent studies with varying results. Therefore, in this review, we aim to summarize the dental phenotype and analyze the different treatment modalities with a focus on dental impairment.
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Affiliation(s)
- Anusha Abdullah
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Sabina Noreen Wuersching
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
| | - Maximilian Kollmuss
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Ina Dewenter
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Leonard Simon Brandenburg
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - David Steybe
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Florian Nepomuk Fegg
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
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Dewenter I, Kumbrink J, Poxleitner P, Smolka W, Liokatis P, Fliefel R, Otto S, Obermeier KT. New insights into redox-related risk factors and therapeutic targets in oral squamous cell carcinoma. Oral Oncol 2023; 147:106573. [PMID: 37951115 DOI: 10.1016/j.oraloncology.2023.106573] [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: 06/20/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 11/13/2023]
Abstract
Oral squamous cell carcinoma (OSCC) is the most common cancer in the oral cavity accounting for 90 % of oral cancer with a global incidence of 350.000 new cases per year. Curative resection along with adjuvant radiation therapy or a combination of radiotherapy with chemotherapy remain as gold standard in treating OSCC. Still, local recurrence, lymph nodal recurrence, and complications of radiation remain the main cause of tumor-related mortality. Reactive oxygen species are not only correlated to the etiology of OSCC due to oxidative DNA damage, lipid peroxidation or effecting signal transduction cascades that effect cell proliferation and tumorigenesis, but are also of great interest in the therapy of OSCC patients. As induced oxidative stress can be used therapeutically for the induction of tumor cell death, redox targets might be a therapeutic addition to the conventional treatment options. In this review, we discuss markers of impaired redox homeostasis as well as potential redox-related treatment targets in OSCC.
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Affiliation(s)
- Ina Dewenter
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilians University, 80337 Munich, Germany.
| | - Joerg Kumbrink
- Institute of Pathology, Faculty of Medicine, Ludwig Maximilians University, Munich, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilians University, 80337 Munich, Germany
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilians University, 80337 Munich, Germany
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilians University, 80337 Munich, Germany
| | - Riham Fliefel
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilians University, 80337 Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilians University, 80337 Munich, Germany
| | - Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilians University, 80337 Munich, Germany
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Obermeier KT, Wuersching SN, Liokatis P, Smolka W, Poxleitner P, Kleye C, Ehrenfeld M, Kollmuss M, Otto S. Metastases of OSCC Based on Oral Lichen Ruber Planus. Cancers (Basel) 2023; 15:4092. [PMID: 37627120 PMCID: PMC10452896 DOI: 10.3390/cancers15164092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/05/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Oral lichen ruber planus (OLP) is a poorly understood chronically inflammatory disease of the oral mucosa. Malignant transformation into oral squamous cell carcinoma (OSCC) is reported in between 1-2% of cases in the literature. After malignant transformation, surgical treatment-meaning tumor resection combined with neck dissection-is recommended. The recommended extent of treatment is controversial in the literature because this kind of OSCC is often a highly differentiated tumor with a lower risk for lymph nodal spreading. This study aims to overview 103 patients treated in our department due to OLP. The primary outcome parameter was the development of metastases in OLP patients compared to a group of OSCC patients without OLP and the comparison of survival in between both groups. Statistical analysis showed a significantly lower risk for patients with OSCC and with OLP for lymph nodal spreading (p = 0.013). Patients with OSCC and without OLP had a 4.76-higher risk for lymph nodal spreading. On the other hand, second metachronous tumor occurred more often in patients with OSCC and OLP. Overall, OSCC based on OLP occurs more often in female patients, is more highly differentiated and comes with a lower risk for metastases but has a higher risk for second metachronous tumors. Therefore, special attention should be paid to patients with OSCC based on OLP when planning adjuvant therapy and clinical follow-up. The indication for postoperative radiation should be made cautiously in this case, and clinical controls should be performed more closely due to the risk of recurrent disease or tumors at different locations.
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Affiliation(s)
- Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Sabina Noreen Wuersching
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig Maximilian University Munich, Goethestrasse 70, 80336 Munich, Germany; (S.N.W.)
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Christin Kleye
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Maximilian Kollmuss
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig Maximilian University Munich, Goethestrasse 70, 80336 Munich, Germany; (S.N.W.)
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
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Steybe D, Poxleitner P, Metzger MC, Rothweiler R, Beck J, Straehle J, Vach K, Weber A, Enderle-Ammour K, Werner M, Schmelzeisen R, Bronsert P. Stimulated Raman histology for histological evaluation of oral squamous cell carcinoma. Clin Oral Investig 2023; 27:4705-4713. [PMID: 37349642 PMCID: PMC10415463 DOI: 10.1007/s00784-023-05098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To investigate whether in patients undergoing surgery for oral squamous cell carcinoma, stimulated Raman histology (SRH), in comparison with H&E-stained frozen sections, can provide accurate diagnoses regarding neoplastic tissue and sub-classification of non-neoplastic tissues. MATERIALS AND METHODS SRH, a technology based on Raman scattering, was applied to generate digital histopathologic images of 80 tissue samples obtained from 8 oral squamous cell carcinoma (OSCC) patients. Conventional H&E-stained frozen sections were then obtained from all 80 samples. All images/sections (SRH and H&E) were analyzed for squamous cell carcinoma, normal mucosa, connective tissue, muscle tissue, adipose tissue, salivary gland tissue, lymphatic tissue, and inflammatory cells. Agreement between SRH and H&E was evaluated by calculating Cohen's kappa. Accuracy of SRH compared to H&E was quantified by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) as well as area under the receiver operating characteristic curve (AUC). RESULTS Thirty-six of 80 samples were classified as OSCC by H&E-based diagnosis. Regarding the differentiation between neoplastic and non-neoplastic tissue, high agreement between H&E and SRH (kappa: 0.880) and high accuracy of SRH (sensitivity: 100%; specificity: 90.91%; PPV: 90.00%, NPV: 100%; AUC: 0.954) were demonstrated. For sub-classification of non-neoplastic tissues, SRH performance was dependent on the type of tissue, with high agreement and accuracy for normal mucosa, muscle tissue, and salivary glands. CONCLUSION SRH provides high accuracy in discriminating neoplastic and non-neoplastic tissues. Regarding sub-classification of non-neoplastic tissues in OSCC patients, accuracy varies depending on the type of tissue examined. CLINICAL RELEVANCE This study demonstrates the potential of SRH for intraoperative imaging of fresh, unprocessed tissue specimens from OSCC patients without the need for sectioning or staining.
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Affiliation(s)
- David Steybe
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany.
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, LMU University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337, Munich, Germany.
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, LMU University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Marc C Metzger
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - René Rothweiler
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob Straehle
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Andreas Weber
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Enderle-Ammour
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Werner
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Tumorbank Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Tumorbank Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Freiburg, Germany
- Core Facility for Histopathology and Digital Pathology, Medical Center, University of Freiburg, Freiburg, Germany
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Brandenburg LS, Voss PJ, Mischkowsky T, Kühle J, Ermer MA, Weingart JV, Rothweiler RM, Metzger MC, Schmelzeisen R, Poxleitner P. Donor site morbidity after computer assisted surgical reconstruction of the mandible using deep circumflex iliac artery grafts: a cross sectional study. BMC Surg 2023; 23:4. [PMID: 36624485 PMCID: PMC9830896 DOI: 10.1186/s12893-022-01899-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Computer Assisted Design and Computer Assisted Manufacturing (CAD/CAM) have revolutionized oncologic surgery of the head and neck. A multitude of benefits of this technique has been described, but there are only few reports of donor site comorbidity following CAD/CAM surgery. METHODS This study investigated comorbidity of the hip following deep circumflex iliac artery (DCIA) graft raising using CAD/CAM techniques. A cross-sectional examination was performed to determine range of motion, muscle strength and nerve disturbances. Furthermore, correlations between graft volume and skin incision length with postoperative donor site morbidity were assessed using Spearman's rank correlation, linear regression and analysis of variance (ANOVA). RESULTS Fifteen patients with a mean graft volume of 21.2 ± 5.7 cm3 and a mean incision length of 228.0 ± 30.0 mm were included. Patients reported of noticeable physical limitations in daily life activities (12.3 ± 11.9 weeks) and athletic activities (38.4 ± 40.0 weeks in mean) following surgery. Graft volume significantly correlated with the duration of the use of walking aids (R = 0.57; p = 0.033) and impairment in daily life activities (R = 0.65; p = 0.012). The length of the scar of the donor-site showed a statistically significant association with postoperative iliohypogastric nerve deficits (F = 4.4, p = 0.037). Patients with anaesthaesia of a peripheral cutaneous nerve had a larger mean scar length (280 ± 30.0 mm) than subjects with hypaesthesia (245 ± 10.1 mm) or no complaints (216 ± 27.7 mm). CONCLUSIONS Despite sophisticated planning options in modern CAD/CAM surgery, comorbidity of the donor site following iliac graft harvesting is still a problem. This study is the first to investigate comorbidity after DCIA graft raising in a patient group treated exclusively with CAD/CAM techniques. The results indicate that a minimal invasive approach in terms of small graft volumes and small skin incisions could help to reduce postoperative symptomatology. Trial registration Retrospectively registered at the German Clinical Trials Register (DRKS-ID: DRKS00029066); registration date: 23/05/2022.
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Affiliation(s)
- Leonard Simon Brandenburg
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Pit Jacob Voss
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Thomas Mischkowsky
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Jan Kühle
- grid.5963.9Department of Orthopedics and Trauma Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Michael Andreas Ermer
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Julia Vera Weingart
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - René Marcel Rothweiler
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Marc Christian Metzger
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Rainer Schmelzeisen
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Philipp Poxleitner
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
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Poxleitner P, Offergeld C. [Midface traumatology: one focus-more than two specialist disciplines?]. HNO 2023; 71:22-27. [PMID: 36534130 DOI: 10.1007/s00106-022-01262-x] [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] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
Midface fractures are a common occurrence and may be associated with other injuries. It is important to perform diagnosis and treatment planning on an interdisciplinary basis. CT is the gold standard diagnostic modality. Classification according to the pattern of fracture is via the LeFort and other systems. Treatment objectives are anatomic repositioning to preserve the function of the eyes, the infraorbital nerve, and facial symmetry, as well as to preserve masticatory function. The number of surgical access routes should be minimized and incisions of the facial skin avoided wherever possible.
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Affiliation(s)
- Philipp Poxleitner
- Department für Zahn‑, Mund- und Kieferheilkunde, Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
| | - Christian Offergeld
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
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Offergeld C, Hofauer B, Poxleitner P, Lagrèze W, Schnell O, Petersen N, Lang F, Burkhardt V, Pfeiffer J, Albrecht T. [Traumatology-an interdisciplinary task: exclusively for educational purposes?]. HNO 2023; 71:8-14. [PMID: 36525032 PMCID: PMC9839790 DOI: 10.1007/s00106-022-01255-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Traumatology of the head and neck region is not only a part of otorhinolaryngology, but also has a large overlap with neighboring disciplines of the head and neck region. In Freiburg, an interdisciplinary lecture on "ENT emergencies" was implemented in the 21/22 winter semester. The aim was to provide an even more realistic view on interdisciplinary patient care and to make evident the areas of intersection of four of the major head disciplines (otorhinolaryngology, neurosurgery, ophthalmology, and maxillofacial surgery). MATERIALS AND METHODS A new, special lecture in otorhinolaryngology was implemented as part of the regular online lecture series accompanying the semester. With reference to the clinical care of ENT emergencies, possible overlaps with neighboring disciplines were identified and explained by the discipline representatives or discussed in front of and with the auditorium. At the end of the semester, all participating students (n = 173) were invited to evaluate the seminar using the survey tool "EvaSys" (EvaSys GmbH, Lüneburg, Germany). In total, 78 students participated in the evaluation process. RESULTS The new lecture concept was very well accepted and immediately ranked top among the interdisciplinary lecture titles within the ENT lecture series. The clear communication of the term "interdisciplinarity" in the sense of a complementary clinical cooperation was also very successful and was appreciated accordingly by students during the evaluation process. CONCLUSION Pragmatic presentation of ideal clinical patient care using an interdisciplinary approach is possible within the regular ENT lecture series. This realistic portrayal, beyond any technical and/or professional differences, is of great interest to students and is considered clinically relevant. Thus, interdisciplinary lectures provide a valuable tool to teach the fundamental values of clinical interdisciplinary management for the best possible patient care.
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Affiliation(s)
- C Offergeld
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - B Hofauer
- Univ.-HNO-Klinik, Universitätsklinikum TUM München, München, Deutschland
| | - P Poxleitner
- Univ.-Klinik für MKG-Chirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - W Lagrèze
- Univ.-Augenklinik, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - O Schnell
- Neurochirurgische Univ.-Klinik, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - N Petersen
- Studiendekanat, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - F Lang
- Univ.-HNO-Klinik, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - V Burkhardt
- Univ.-HNO-Klinik, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J Pfeiffer
- HNO-Praxis am Theater, Freiburg, Deutschland
| | - T Albrecht
- Univ.-HNO-Klinik, Universitätsklinikum Tübingen, Tübingen, Deutschland
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9
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Rothweiler R, Gerlach V, Voss P, Poxleitner P, Ermer M, Gross C, Schwer C, Vach K, Kalbhenn J, Metzger M. Aspirin, heparin and ischemia time in microvascular free flap surgery - their influence and an optimal anticoagulation protocol. J Stomatol Oral Maxillofac Surg 2022; 123:e556-e562. [PMID: 35272089 DOI: 10.1016/j.jormas.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Microvascular surgery has become a standardized technique for reconstruction of large tissue defects in Head and Neck Reconstructive Surgery. However, the main dreaded complications are thrombosis of blood vessels or major bleeding after surgery. Several different anticoagulation protocols have been established in the last decades to overcome these problems with varying degrees of success. METHODS Over a period of six years, a standardized anticoagulation protocol including acetylsalicylic acid (ASA) and unfractionated heparin (UFH) for direct intraoperative and postoperative administration was established, optimized and compared to a previously used non-standardized protocol. A total of 178 flap surgeries were included in the development and optimization process of the protocol. RESULTS ASA significantly increased the risk of complications when used for longer than 72 h (OR = 2.52; p = 0.002; 95% CI 1.39-4.59). Administration of UFH reduced flap loss (bolus: OR 0.68; p = 0.47; 95% CI 0.24-1.93; continuous UFH administration: OR = 0.61; p = 0.33; 95% CI 0.22-1.66), however doses greater than 500 IU/ h of UFH as continuous infusion increased the risk of complications. Reduction in ischemia time had no effect on the occurrence of complications. CONCLUSION Anticoagulation regimes in microvascular surgery can influence the postoperative complication rate. The optimal protocol should consist of a combination of ASA and UFH for the intraoperative and direct postoperative phase. Prolonged administration of ASA as well as doses >500 IU/ h of UFH are to be avoided due to the increased complication rate.
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Affiliation(s)
- René Rothweiler
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vanessa Gerlach
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pit Voss
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Ermer
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Gross
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Schwer
- Department of Anesthesiology and Critical Care, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marc Metzger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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10
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Steybe D, Poxleitner P, Metzger MC, Schmelzeisen R, Russe MF, Fuessinger MA, Brandenburg LS, Voss PJ, Schlager S. Analysis of the accuracy of computer‐assisted
DCIA
flap mandibular reconstruction applying a novel approach based on geometric morphometrics. Head Neck 2022; 44:2810-2819. [DOI: 10.1002/hed.27196] [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] [Received: 04/14/2022] [Revised: 07/27/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- David Steybe
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Marc C. Metzger
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Maximilian F. Russe
- Department of Diagnostic and Interventional Radiology Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Marc Anton Fuessinger
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Leonard S. Brandenburg
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Pit J. Voss
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Stefan Schlager
- Department of Oral and Maxillofacial Surgery, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
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11
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Poxleitner P, Voss PJ, Steybe D, Seibert LM, Zeiter S, Stoddart MJ, Schmelzeisen R, Otto S. Computed Tomography-Based Investigation on the Effects of Intravenous Bisphosphonate Administration on Tooth Growth in a Minipig Animal Model. Medicina (Kaunas) 2022; 58:medicina58060778. [PMID: 35744041 PMCID: PMC9230135 DOI: 10.3390/medicina58060778] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The objective of this study was to evaluate the effects of bisphosphonate (BP) administration on tooth growth, using CT-data of a minipig animal model investigation. Materials and Methods: Tooth growth was evaluated in minipigs, with eight animals receiving weekly zoledronate (ZOL) and three animals serving as the control group. Tooth growth was evaluated at the right 2nd molar (M2) in the maxilla. A computed tomography-based measuring method was applied to evaluate tooth growth in the coronal-apical, buccal-oral and mesial-distal axis. Results: ZOL-administration was found to impact tooth growth in all evaluated measuring axes, with the highest effect observed in the coronal-apical axis. Conclusions: Detrimental effects of BP administration on growing teeth have been reported by a number of investigators. The results of this investigation demonstrate that intravenous ZOL affects the growth of the whole tooth within a short period of administration. With BPs being administered to a growing number of pediatric patients, further studies should be conducted to qualify and quantify the effects of BPs on developing teeth.
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Affiliation(s)
- Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (P.J.V.); (D.S.); (L.-M.S.); (R.S.)
- Correspondence:
| | - Pit J. Voss
- Department of Oral and Maxillofacial Surgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (P.J.V.); (D.S.); (L.-M.S.); (R.S.)
| | - David Steybe
- Department of Oral and Maxillofacial Surgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (P.J.V.); (D.S.); (L.-M.S.); (R.S.)
| | - Lisa-Marie Seibert
- Department of Oral and Maxillofacial Surgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (P.J.V.); (D.S.); (L.-M.S.); (R.S.)
| | - Stephan Zeiter
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (S.Z.); (M.J.S.)
| | - Martin J. Stoddart
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (S.Z.); (M.J.S.)
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (P.J.V.); (D.S.); (L.-M.S.); (R.S.)
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstr. 2a, 80337 Munich, Germany;
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12
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Steybe D, Poxleitner P, Metzger MC, Brandenburg LS, Schmelzeisen R, Bamberg F, Tran PH, Kellner E, Reisert M, Russe MF. Automated segmentation of head CT scans for computer-assisted craniomaxillofacial surgery applying a hierarchical patch-based stack of convolutional neural networks. Int J Comput Assist Radiol Surg 2022; 17:2093-2101. [PMID: 35665881 PMCID: PMC9515026 DOI: 10.1007/s11548-022-02673-5] [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: 12/30/2021] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
Purpose Computer-assisted techniques play an important role in craniomaxillofacial surgery. As segmentation of three-dimensional medical imaging represents a cornerstone for these procedures, the present study was aiming at investigating a deep learning approach for automated segmentation of head CT scans. Methods The deep learning approach of this study was based on the patchwork toolbox, using a multiscale stack of 3D convolutional neural networks. The images were split into nested patches using a fixed 3D matrix size with decreasing physical size in a pyramid format of four scale depths. Manual segmentation of 18 craniomaxillofacial structures was performed in 20 CT scans, of which 15 were used for the training of the deep learning network and five were used for validation of the results of automated segmentation. Segmentation accuracy was evaluated by Dice similarity coefficient (DSC), surface DSC, 95% Hausdorff distance (95HD) and average symmetric surface distance (ASSD). Results Mean for DSC was 0.81 ± 0.13 (range: 0.61 [mental foramen] – 0.98 [mandible]). Mean Surface DSC was 0.94 ± 0.06 (range: 0.87 [mental foramen] – 0.99 [mandible]), with values > 0.9 for all structures but the mental foramen. Mean 95HD was 1.93 ± 2.05 mm (range: 1.00 [mandible] – 4.12 mm [maxillary sinus]) and for ASSD, a mean of 0.42 ± 0.44 mm (range: 0.09 [mandible] – 1.19 mm [mental foramen]) was found, with values < 1 mm for all structures but the mental foramen. Conclusion In this study, high accuracy of automated segmentation of a variety of craniomaxillofacial structures could be demonstrated, suggesting this approach to be suitable for the incorporation into a computer-assisted craniomaxillofacial surgery workflow. The small amount of training data required and the flexibility of an open source-based network architecture enable a broad variety of clinical and research applications. Supplementary Information The online version contains supplementary material available at 10.1007/s11548-022-02673-5.
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Affiliation(s)
- David Steybe
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.,Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Phuong Hien Tran
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Department of Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Department of Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Frederik Russe
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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13
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Fuessinger MA, Schwarz S, Gass M, Poxleitner P, Brandenburg LS, Schlager S, Metzger MC. Correction to: The statistical shape model as a quality assurance measure in the treatment of complex midface fractures: a case control study. Head Face Med 2022; 18:3. [PMID: 35081967 PMCID: PMC8790834 DOI: 10.1186/s13005-022-00306-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Marc Anton Fuessinger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Steffen Schwarz
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Mathieu Gass
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Stefan Schlager
- Department of Physical Anthropology, Albert-Ludwigs University Freiburg, Hebelstr. 29, 79104, Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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14
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Brandenburg LS, Metzger MC, Poxleitner P, Voss PJ, Vach K, Hell J, Hasel K, Weingart JV, Schwarz SJ, Ermer MA. Effects of Red Blood Cell Transfusions on Distant Metastases of Oral Squamous Cell Carcinomas. Cancers (Basel) 2021; 14:cancers14010138. [PMID: 35008301 PMCID: PMC8750075 DOI: 10.3390/cancers14010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Patients with distant metastasis of oral squamous cell carcinoma should be identified at an early stage of disease. In this study, we investigated if patients who received red blood cell transfusions are at risk for the development of distant metastasis. A positive correlation was found between RBC transfusion (HR = 2.42) and the occurrence of M+ in a multivariate regression model. Therefore, the administration of RBC can be considered as an independent prognostic factor and special attention should be paid to its detrimental effects in the perioperative management of OSCC patients. Abstract There is no consensus on the effect of red blood cell (RBC) transfusions on patients with oral squamous cell carcinoma (OSCC). The aim of this study was to investigate the association between RBC administration and the occurrence of distant metastases (M+) after surgical treatment of OSCC. All medical records of patients who underwent primary surgery for OSCC in our department (2003–2019) were analyzed retrospectively (n = 609). Chi and Cox regression models were used to analyze the influence of transfusion on the development of M+, and survival rates. Kaplan–Meier curves were used for graphical presentation. A multitude of patient-specific factors showed a statistical impact in univariate analysis (transfusion, age, gender, diabetes, pT, pN, L, V, Pn, G, UICC, adjuvant therapy, free microvascular transplant, preoperative hemoglobin level). Transfusion status and pN stage were the only variables that showed a significant correlation to M+ in the multivariate Cox model. The hazard ratios for the occurrence of M+ were 2.42 for RBC transfusions and 2.99 for pN+. Administration of RBC transfusions was identified as a significant prognostic parameter for the occurrence of distant metastases after surgical treatment of OSCC. Hence, the administration of RBC transfusions should be considered carefully in the perioperative management.
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Affiliation(s)
- Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
- Correspondence: ; Tel.: +49-761-270-49240
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Zinkmattenstr. 6A, 79108 Freiburg, Germany;
| | - Johannes Hell
- Department of Anesthesiology and Critical Care, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany;
| | - Konstantin Hasel
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Julia Vera Weingart
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Steffen Jochen Schwarz
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Michael Andreas Ermer
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
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15
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Steybe D, Poxleitner P, Voss PJ, Metzger MC, Schmelzeisen R, Bamberg F, Kim S, Russe MF. Evaluation of computed tomography settings in the context of visualization and discrimination of low dose injections of a novel liquid soft tissue fiducial marker in head and neck imaging. BMC Med Imaging 2021; 21:157. [PMID: 34702192 PMCID: PMC8549337 DOI: 10.1186/s12880-021-00689-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Intraoperative incorporation of radiopaque fiducial markers at the tumor resection surface can provide useful assistance in identifying the tumor bed in postoperative imaging for RT planning and radiological follow-up. Besides titanium clips, iodine containing injectable liquid fiducial markers represent an option that has emerged more recently for this purpose. In this study, marking oral soft tissue resection surfaces, applying low dose injections of a novel Conformité Européenne (CE)-marked liquid fiducial marker based on sucrose acetoisobutyrate (SAIB) and iodinated SAIB (x-SAIB) was investigated. Methods Visibility and discriminability of low dose injections of SAIB/x-SAIB (10 µl, 20 µl, 30 µl) were systematically studied at different kV settings used in clinical routine in an ex-vivo porcine mandible model. Transferability of the preclinical results into the clinical setting and applicability of DE-CT were investigated in initial patients.
Results Markers created by injection volumes as low as 10 µl were visible in CT imaging at all kV settings applied in clinical routine (70–120 kV). An injection volume of 30 µl allowed differentiation from an injection volume of 10 µl. In a total of 118 injections performed in two head and neck cancer patients, markers were clearly visible in 83% and 86% of injections. DE-CT allowed for differentiation between SAIB/x-SAIB markers and other hyperdense structures. Conclusions Injection of low doses of SAIB/x-SAIB was found to be a feasible approach to mark oral soft tissue resection surfaces, with injection volumes as low as 10 µl found to be visible at all kV settings applied in clinical routine. With the application of SAIB/x-SAIB reported for tumors of different organs already, mostly applying relatively large volumes for IGRT, this study adds information on the applicability of low dose injections to facilitate identification of the tumor bed in postoperative CT and on performance of the marker at different kV settings used in clinical routine.
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Affiliation(s)
- David Steybe
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Albert-Ludwigs University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Albert-Ludwigs University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.,Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Albert-Ludwigs University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Albert-Ludwigs University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Albert-Ludwigs University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Suam Kim
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Frederik Russe
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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16
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Fuessinger MA, Schwarz S, Gass M, Poxleitner P, Brandenburg L, Schlager S, Metzger MC. The statistical shape model as a quality assurance measure in the treatment of complex midface fractures: a case control study. Head Face Med 2021; 17:44. [PMID: 34670566 PMCID: PMC8527631 DOI: 10.1186/s13005-021-00296-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Complex bilateral midface fractures necessitate a surgically challenging procedure to preserve or restore the occlusion and the sensitive eye area. In this case control study, we aim to show the potential of a statistical shape model (SSM) for measuring the quality of the midface reconstruction, compared to the estimated preoperative situation. Methods An individualized SSM was postoperatively registered on 19 reconstructed complex bilateral midface fractures. Using this SSM, the distances from the simulated preoperative situation to the postoperative positions of the fracture segments were calculated. The fracture lines for Le Fort II, Le Fort III, and NOE fractures were chosen as reference points for the distance measurements. Results The SSM could be registered on all 19 complex bilateral midface fractures. All analyzed fractures showed a dorsal impaction (negative values) of the midface. Le Fort II fractures showed deviation values of –0.98 ± 4.6 mm, Le Fort III fractures showed values of –3.68 ± 3.6 mm, NOE type 2 fractures showed values of –0.25 ± 4.6 mm, and NOE type 1 fractures showed values of –0.25 ± 4.6 mm. Conclusions The SSM can be used to measure the quality of the achieved reduction of complex bilateral midface fractures based on the estimated preoperative situation. Trial registration DRKS00009719.
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Affiliation(s)
- Marc Anton Fuessinger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Steffen Schwarz
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Mathieu Gass
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Leonard Brandenburg
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Stefan Schlager
- Department of Physical Anthropology, Albert-Ludwigs University Freiburg, Hebelstr. 29, 79104, Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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Hoefflin R, Lazarou A, Hess ME, Reiser M, Wehrle J, Metzger P, Frey AV, Becker H, Aumann K, Berner K, Boeker M, Buettner N, Dierks C, Duque-Afonso J, Eisenblaetter M, Erbes T, Fritsch R, Ge IX, Geißler AL, Grabbert M, Heeg S, Heiland DH, Hettmer S, Kayser G, Keller A, Kleiber A, Kutilina A, Mehmed L, Meiss F, Poxleitner P, Rawluk J, Ruf J, Schäfer H, Scherer F, Shoumariyeh K, Tzschach A, Peters C, Brummer T, Werner M, Duyster J, Lassmann S, Miething C, Boerries M, Illert AL, von Bubnoff N. Transitioning the Molecular Tumor Board from Proof of Concept to Clinical Routine: A German Single-Center Analysis. Cancers (Basel) 2021; 13:1151. [PMID: 33800365 PMCID: PMC7962829 DOI: 10.3390/cancers13051151] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023] Open
Abstract
Molecular precision oncology faces two major challenges: first, to identify relevant and actionable molecular variants in a rapidly changing field and second, to provide access to a broad patient population. Here, we report a four-year experience of the Molecular Tumor Board (MTB) of the Comprehensive Cancer Center Freiburg (Germany) including workflows and process optimizations. This retrospective single-center study includes data on 488 patients enrolled in the MTB from February 2015 through December 2018. Recommendations include individual molecular diagnostics, molecular stratified therapies, assessment of treatment adherence and patient outcomes including overall survival. The majority of MTB patients presented with stage IV oncologic malignancies (90.6%) and underwent an average of 2.1 previous lines of therapy. Individual diagnostic recommendations were given to 487 patients (99.8%). A treatment recommendation was given in 264 of all cases (54.1%) which included a molecularly matched treatment in 212 patients (43.4%). The 264 treatment recommendations were implemented in 76 patients (28.8%). Stable disease was observed in 19 patients (25.0%), 17 had partial response (22.4%) and five showed a complete remission (6.6%). An objective response was achieved in 28.9% of cases with implemented recommendations and for 4.5% of the total population (22 of 488 patients). By optimizing the MTB workflow, case-discussions per session increased significantly while treatment adherence and outcome remained stable over time. Our data demonstrate the feasibility and effectiveness of molecular-guided personalized therapy for cancer patients in a clinical routine setting showing a low but robust and durable disease control rate over time.
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Affiliation(s)
- Rouven Hoefflin
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Adriana Lazarou
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Maria Elena Hess
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Meike Reiser
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Julius Wehrle
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Anna Verena Frey
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Heiko Becker
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Konrad Aumann
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Kai Berner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Obstetrics and Gynaecology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Martin Boeker
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Nico Buettner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christine Dierks
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Jesus Duque-Afonso
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Michel Eisenblaetter
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Freiburg, Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Thalia Erbes
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Obstetrics and Gynaecology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Ralph Fritsch
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Isabell Xiang Ge
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Obstetrics and Gynaecology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Anna-Lena Geißler
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Markus Grabbert
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Urology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Steffen Heeg
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Dieter Henrik Heiland
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Simone Hettmer
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Pediatric Hematology and Oncology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Gian Kayser
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Alexander Keller
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Anita Kleiber
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Alexandra Kutilina
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Leman Mehmed
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Clinical Cancer Registry, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Frank Meiss
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Dermatology and Venerology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Philipp Poxleitner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Oral and Maxillofacial Surgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Justyna Rawluk
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Juri Ruf
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Nuclear Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Henning Schäfer
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Khalid Shoumariyeh
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Andreas Tzschach
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute of Human Genetics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christoph Peters
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
- Center for Biological Signaling Studies BIOSS, University of Freiburg, 79104 Freiburg, Germany
| | - Tilman Brummer
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
- Center for Biological Signaling Studies BIOSS, University of Freiburg, 79104 Freiburg, Germany
| | - Martin Werner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Silke Lassmann
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Center for Biological Signaling Studies BIOSS, University of Freiburg, 79104 Freiburg, Germany
| | - Cornelius Miething
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Melanie Boerries
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Anna L. Illert
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Nikolas von Bubnoff
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Steybe D, Russe MF, Ludwig U, Sprave T, Vach K, Semper-Hogg W, Schmelzeisen R, Voss PJ, Poxleitner P. Intraoperative marking of the tumour resection surface for improved radiation therapy planning in head and neck cancer: preclinical evaluation of a novel liquid fiducial marker. Dentomaxillofac Radiol 2021; 50:20200290. [PMID: 32915672 DOI: 10.1259/dmfr.20200290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate a novel liquid fiducial marker for intraoperative marking of the tumour resection surface in oral cancer patients to facilitate precise postoperative delineation of the interface between the tumour resection border and reconstructed tissue for intensity-modulated radiation therapy. METHODS A total of 200 markers were created by injecting the volumes of 10 µl, 20 µl, 30 µl, 40 µl and 50 µl of a liquid marker composed of sucrose acetoisobutyrate (SAIB) and iodinated sucrose acetoisobutyrate (x-SAIB) into the soft tissue of porcine mandible segments. Visibility of the resulting markers was quantified by threshold-based segmentation of the marker volume in CT- and CBCT imaging and by a comparison of signal intensities in MRI. RESULTS Even the lowest volume of SAIB-/x-SAIB investigated (10 µl) resulted in a higher visibility (CTSoft tissue: 88.18 ± 13.23 µl; CTBone: 49.55 ± 7.62 µl; CBCT: 54.65 ± 12.58 µl) than observed with the incorporation of titanium ligature clips (CTSoft tissue: 50.15 ± 7.50 mm3; CTBone: 23.90 ± 3.39 mm3; CBCT: 33.80 ± 9.20 mm3). Markers created by the injection of 10 µl and 20 µl could reliably be delineated from markers created by the injection of higher volumes. CONCLUSION SAIB/x-SAIB, which has recently become available as a Conformité Européenne (CE)-marked fiducial marker, provides an option for fast and reliable production of markers with excellent visibility in imaging modalities used in oral cancer radiation therapy (RT) planning routine.
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Affiliation(s)
- David Steybe
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Frederik Russe
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ute Ludwig
- Medical Physics, Department of Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Wiebke Semper-Hogg
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Otto S, Pautke C, Arens D, Poxleitner P, Eberli U, Nehrbass D, Zeiter S, Stoddart MJ. A Drug Holiday Reduces the Frequency and Severity of Medication-Related Osteonecrosis of the Jaw in a Minipig Model. J Bone Miner Res 2020; 35:2179-2192. [PMID: 32568416 PMCID: PMC7689727 DOI: 10.1002/jbmr.4119] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023]
Abstract
Treatment of medication-related osteonecrosis of the jaw (MRONJ) is challenging and no clear consensus has been achieved. This study investigated preventive measures recommended for tooth extractions under antiresorptive (AR) treatment and the role of discontinuation of AR therapy to avoid the onset of MRONJ in a minipig model. Thirty-six Göttingen minipigs were divided into four groups. Group 1 (negative control): tooth extractions but no zoledronate (ZOL). Group 2 (positive control): weekly ZOL infusions for 12 weeks followed by tooth extractions without wound management followed by 8 weeks of ZOL treatment. Group 3: weekly ZOL infusions for 12 weeks followed by tooth extractions; surgical wound management (resection of sharp bone edges, mucoperiosteal coverage); and continuation of ZOL infusions for 8 weeks plus antibiotic treatment. Group 4: 12 weeks of ZOL infusions followed by a drug holiday for 6 weeks. Tooth extractions with preventive wound management followed by antibiotic treatment for 8 weeks but no ZOL infusions. Jawbones were subjected to macroscopic, radiological (CT and micro-CT) and histopathological investigations. No clinical cases of MRONJ were observed in the negative group, in the positive control all animals developed MRONJ. Group 3 developed MRONJ in 83% of cases. With a drug holiday, 40% developed MRONJ in areas of tooth extraction. This is the first large animal model that reduces the occurrence of MRONJ following tooth extraction by the implementation of a drug holiday combined with antibiotic prophylaxis and smoothening of sharp bony edges. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research..
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Affiliation(s)
- Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University, Munich, Germany
| | - Christoph Pautke
- Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University, Munich, Germany
| | | | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs-University, Freiburg, Germany
| | | | | | | | - Martin J Stoddart
- AO Research Institute Davos, Davos, Switzerland.,Department of Oral and Maxillofacial Surgery, Albert-Ludwigs-University, Freiburg, Germany
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Spanou A, Nelson K, Ermer MA, Steybe D, Poxleitner P, Voss PJ. Primary wound closure and perioperative antibiotic therapy for prevention of bisphosphonate-related osteonecrosis of the jaw after tooth extraction. Quintessence Int 2020; 51:220-228. [PMID: 32020132 DOI: 10.3290/j.qi.a43949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Tooth extractions are suspected to be a major trigger for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Preventive measures like perioperative antibiotic therapy and primary wound closure have been found to be effective in preventing the development of BRONJ following tooth extraction. The aim of this study was to present long-term results of a treatment protocol for patients under bisphosphonate therapy requiring tooth extraction. METHOD AND MATERIALS Between January 2008 and December 2012, 232 tooth extractions were performed in 84 patients under current or previous bisphosphonate treatment. Extractions were performed applying an atraumatic technique under prolonged intravenous antibiotic therapy. The bony edges were rounded off meticulously and the extraction sockets were covered with a mucoperiosteal flap. RESULTS Out of 84 patients, two developed osteonecrosis of the jaw (ONJ), resulting in an incidence-rate of 2.4%. Both ONJ patients had received radiation therapy to the head and neck region following tooth extraction. The remaining 82 patients had uneventful healing and did not present any signs or symptoms of BRONJ during the follow-up period of 41.5 months. CONCLUSION Tooth extractions, if performed under certain circumstances, would not seem to constitute a major risk factor for the development of BRONJ. The treatment protocol presented in this article seems to be highly effective in preventing development of ONJ after tooth extraction in patients under current or previous bisphosphonate therapy.
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Fuessinger MA, Schwarz S, Neubauer J, Cornelius CP, Gass M, Poxleitner P, Zimmerer R, Metzger MC, Schlager S. Virtual reconstruction of bilateral midfacial defects by using statistical shape modeling. J Craniomaxillofac Surg 2019; 47:1054-1059. [DOI: 10.1016/j.jcms.2019.03.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/24/2019] [Accepted: 03/25/2019] [Indexed: 11/26/2022] Open
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Voss PJ, Steybe D, Fuessinger MA, Semper-Hogg W, Metzger M, Schmelzeisen R, Poxleitner P. Vascularized scapula and latissimus dorsi flap for CAD/CAM assisted reconstruction of mandibular defects including the mandibular condyle: technical report and clinical results. BMC Surg 2019; 19:67. [PMID: 31242878 PMCID: PMC6595593 DOI: 10.1186/s12893-019-0535-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/19/2019] [Indexed: 11/26/2022] Open
Abstract
Background Reconstruction of mandibular continuity and function after tumor resection is challenging, particularly in cases including the mandibular condyle. Various approaches for reconstruction after disarticulation resection have been reported. However, the scapula flap has received little attention as a treatment option in these cases. Patients and methods Three cases of computer aided design and computer aided manufacturing (CAD/CAM) assisted reconstruction after disarticulation resection using a vascularized scapula and latissimus dorsi flap are reported. All cases required reconstruction of the mandibular ramus and condyle in combination with the reconstruction of large and complex soft tissue defects. Results The surgical procedure was deemed successful in all cases. The scapula flap could be placed as preoperatively planned and patients regained their preoperative occlusion pattern and satisfying mouth opening-ranges. The large soft tissue defects could reliably be reconstructed using a latissimus dorsi flap. Conclusions The scapula and latissimus dorsi flap can be considered a suitable option for the reconstruction of mandibular disarticulation resection defects in combination with large soft tissue defects.
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Affiliation(s)
- Pit Jacob Voss
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - David Steybe
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Marc Anton Fuessinger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Wiebke Semper-Hogg
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Marc Metzger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany. .,Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Voss P, Poxleitner P, Metzger M, Schmelzeisen R, Schlager S, Füßinger M. Accuracy of CAD-CAM manufactured implants and DCIA transplants. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.460] [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: 10/26/2022]
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Poxleitner P, Voss PJ, Steybe D, Schlager S, Schwarz S, Fuessinger MA, Schmelzeisen R, Metzger M. Catching condyle – Endoscopic-assisted transoral open reduction and rigid fixation of condylar process fractures using an auto reposition and fixation osteosynthesis plate. J Craniomaxillofac Surg 2019; 47:778-785. [DOI: 10.1016/j.jcms.2019.01.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/14/2019] [Accepted: 01/28/2019] [Indexed: 11/28/2022] Open
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Poxleitner P, Steybe D, Bublitz B, Schlager S, Fuessinger MA, Voss PJ, Schmelzeisen R, Cornelius CP, Metzger M. Analysis of the accuracy of a novel preformed osteosynthesis plate for the reduction and fixation of zygomaticomaxillary complex fractures. J Craniomaxillofac Surg 2019; 47:951-958. [PMID: 30935849 DOI: 10.1016/j.jcms.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/05/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION There has been a shift toward surgical treatment of ZMC (zygomaticomaxillary complex) fractures with open reduction and subsequent fixation in the past decades. Anatomically preformed osteosynthesis plates, already used in the field of craniomaxillofacial surgery for the treatment of fractures of the mandible and the orbit, might be a suitable option for ZMC fractures as well. MATERIAL AND METHODS A statistical shape model was created from 179 cranial CT scans. Based on this surface model, an anatomically preformed plate for the reduction and fixation of ZMC fractures was developed in 3 sizes (S, M, L). Virtual analysis of the accuracy of the plate was performed on a dataset consisting of 120 CT scans. RESULTS Within a determined tolerance range of 0-1.5 mm, analysis revealed a high accuracy of the plate in 70-87 % of the CT scans. The S-sized plate has the highest overall accuracy, whereas the L-sized plate has highest accuracy at the "base" region which is essential for the placement of the plate. DISCUSSION The newly developed plate can be placed via an intraoral approach and analysis of the plate has confirmed its accuracy to be sufficient to ensure an adequate fracture reduction and fixation. It thus might allow for a less extensive approach and less approaches/incisions necessary overall to reduce and fixate ZMC fractures.
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Affiliation(s)
- Philipp Poxleitner
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany; Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Germany.
| | - David Steybe
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Britta Bublitz
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Stefan Schlager
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Marc Anton Fuessinger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Pit Jacob Voss
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Carl-Peter Cornelius
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstr. 2a, 80337, Munich, Germany
| | - Marc Metzger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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Voss PJ, Matsumoto A, Alvarado E, Schmelzeisen R, Duttenhoefer F, Poxleitner P. Correction to: Treatment of stage II medication-related osteonecrosis of the jaw with necrosectomy and autologous bone marrow mesenchymal stem cells. Odontology 2019; 107:269. [PMID: 30721386 DOI: 10.1007/s10266-018-00409-z] [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: 10/27/2022]
Abstract
In the Original publication of the article, the co-author has been misspelled as Fabian Duttenhöfer in the article "Treatment of stage II medication-related osteonecrosis of the jaw with necrosectomy and autologous bone marrow mesenchymal stem cells" published in October 2017, Volume 105, Issue 4 of Odontology. The correct name is "Fabian Duttenhoefer".
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Affiliation(s)
- Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
| | - Akihiko Matsumoto
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Esteban Alvarado
- Section of Orthodontics and Maxillofacial Surgery, Latinamerican University of Science and Technology, 100 metros sur del Periódico La República, San José, Barrio Tournón, Costa Rica
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
| | - Fabian Duttenhoefer
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
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Poxleitner P, Engelhardt M, Schmelzeisen R, Voss P. The Prevention of Medication-related Osteonecrosis of the Jaw. Dtsch Arztebl Int 2018; 114:63-69. [PMID: 28241916 DOI: 10.3238/arztebl.2017.0063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 07/21/2016] [Accepted: 11/09/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a preventable complication of antiresorptive treatment. It arises in 1-20% of patients with bone metastases of solid tumors and hematologic malignancies and in 0.1-2% of patients being treated for osteoporosis with bisphosphonates. Depending on the underlying disease and medication dosage, the risk of MRONJ can be elevated even in the first year of antiresorptive treatment. The treatment of MRONJ is difficult and often involves surgery of the jaw. METHODS We systematically reviewed publications retrieved by a selective search for literature on the prevention of MRONJ in the PubMed and Cochrane Library databases and with the aid of the Google Scholar search engine. RESULTS 15 of 559 retrieved publications were included in the analysis. The quality of the evidence in the studies was generally moderate to low, with most of them being case series. In one case series of over 1200 patients with multiple myeloma, the incidence of MRONJ was lowered from 4.6% to 0.8% through regular dental checkups and improved oral hygiene. Tooth extraction, in particular, is associated with a high risk of MRONJ. In a retrospective study, 57% of patients who underwent tooth extraction without antibiotic prophylaxis developed MRONJ, compared to 0% with antibiotic prophylaxis. CONCLUSION Before antiresorptive medication is begun, oral hygiene should be improved. Moreover, it seems that perioperative antibiotic prophylaxis and adequate plastic wound closure can often prevent MRONJ. In view of the fact that bisphosphonates can persist in bone for more than 15 years, patients should be thoroughly informed of the risk that antiresorptive treatment can cause MRONJ, and the measures discussed should be initiated.
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Affiliation(s)
- Philipp Poxleitner
- Center for Dental Medicine, Department of Oral and Maxillofacial Surgery and Regional Plastic Surgery, Medical Center-University of Freiburg; Department of Medicine I: Hematology, Oncology, and Stem-Cell Transplantation, Medical Center-University of Freiburg
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Reissmann DR, Poxleitner P, Heydecke G. Location, intensity, and experience of pain after intra-oral versus extra-oral bone graft harvesting for dental implants. J Dent 2018; 79:102-106. [PMID: 31097284 DOI: 10.1016/j.jdent.2018.10.011] [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: 06/21/2018] [Revised: 10/13/2018] [Accepted: 10/25/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The reconstruction of extended and complex defects of the alveolar bone is a frequent requirement prior to implant placement. The aim of this study was to assess and compare location, intensity, and experience of pain after bone graft harvesting for dental implants with respect to the donor site. METHODS In this prospective non-randomized intervention study, a consecutive sample of 23 patients who received autologous bone grafts from intra-oral (IO; N = 8) or extra-oral (EO; N = 15) donor sites prior to insertion of dental implants for fixed dental prostheses were recruited. All patients completed a self-administered questionnaire regarding pain location, intensity, and experience at baseline (B; before surgery), at the first follow-up (F1; 3 days after surgery), and at the second follow-up (F2; 4 weeks after surgery). Relative Risk Ratios (RRR) were determined for pain locations. For pain intensity and pain experience, 95% confidence intervals were evaluated using percentiles of a bootstrap with 1000 replications to assess statistical significance. RESULTS Both patient groups did perceive pain in the mouth/face after the intervention, but patients in the EO donor site group had additional pain at the hip, felt their pain longer and of higher intensity, and had more negative pain experiences than patients with IO donor sites (all p < 0.05). CONCLUSIONS While both IO and EO bone graft harvesting are procedures that are associated with pain in a large proportion of patients, an EO donor site is expected to lead to more pain-related burdens than an IO donor site. CLINICAL SIGNIFICANCE Prior to bone graft harvesting, surgeons can now provide patients with tailored information regarding pain perceptions to be expected. This will help the patients with making an informed decision, and on whether or not to agree with surgery.
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Affiliation(s)
- Daniel R Reissmann
- Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Philipp Poxleitner
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Steybe D, Voss PJ, Ermer MA, Fuessinger MA, Schmelzeisen R, Poxleitner P. Necrotizing fasciitis as a complication of osteonecrosis of the jaw related to oral bisphosphonate application in a patient with osteoporosis: a case report. Oral Maxillofac Surg 2018; 23:83-89. [PMID: 30288621 DOI: 10.1007/s10006-018-0725-7] [Citation(s) in RCA: 2] [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: 08/01/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Necrotizing fasciitis has been reported as a complication secondary to bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a low number of patients. The only report of such a case in an osteoporosis patient found in current literature was related to short-term bisphosphonate but long time corticosteroid and methotrexate treatment. CASE PRESENTATION In this article, we report a case of necrotizing fasciitis secondary to osteonecrosis of the jaw related to long-term oral bisphosphonate treatment in an osteoporosis patient additionally suffering from poorly controlled type 2 diabetes. Diabetes mellitus not only has been reported to be a systemic risk factor regarding BRONJ but also to be the most common comorbidity in patients presenting with necrotizing fasciitis and to increase mortality of this condition. Necrotizing fasciitis and BRONJ in the patient could eventually be resolved by a surgical approach and intravenous antibiotic therapy. CONCLUSIONS The case presented suggests diabetes mellitus potentially having been an important factor in the particularly unfavorable course of therapy. It emphasizes the importance of an adequate therapy and surveillance of modifiable systemic risk factors like diabetes mellitus in patients being at risk for development of BRONJ. If necrotizing fasciitis is suspected, early diagnosis and aggressive surgical and medical management are essential to minimize morbidity and mortality.
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Affiliation(s)
- David Steybe
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Pit Jacob Voss
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Michael Andreas Ermer
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Marc Anton Fuessinger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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Voss P, Poxleitner P, Schmelzeisen R, Stricker A, Semper-Hogg W. Update MRONJ and perspectives of its treatment. Journal of Stomatology, Oral and Maxillofacial Surgery 2017; 118:232-235. [DOI: 10.1016/j.jormas.2017.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/20/2017] [Indexed: 11/16/2022]
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Ermer MA, Kottmann SC, Otten JE, Wittmer A, Poxleitner P, Pelz K. In Vitro Investigation of the Antimicrobial Effect of Three Bisphosphonates Against Different Bacterial Strains. J Oral Maxillofac Surg 2017; 76:553-560. [PMID: 28916324 DOI: 10.1016/j.joms.2017.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE Since the first descriptions of medication-related osteonecrosis of the jaw (MRONJ) in 2003, the pathogenesis has remained unanswered. Recent histomorphometric studies have found several microorganisms, including Actinomyces, Bacillus, Fusobacterium, Staphylococcus, Streptococcus, Selenomonas, Treponema, and Candida albicans in necrotic bone. Polymerase chain reaction studies have recently confirmed the occurrence of 48 genera. Only a few studies have examined the antimicrobial effect of bisphosphonates (BPs). The influence of bacterial growth on the etiology remains unclear. The aim of the present study was the in vitro investigation of the antimicrobial effect of 3 BPs against different bacterial strains. MATERIALS AND METHODS The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of 48 strains from 40 species were determined in microdilution assays against pamidronic, ibandronic, and zoledronic acid. RESULTS Growth of gram-positive oral microbiota, which account for most microorganisms in MRONJ, was present for 2 of 22 species; 6 of 26 gram-negative species and 9 of 13 anaerobes were inhibited. The MIC values were compared with the BP bone concentrations from previous reports. Of the 48 strains, 9 had an MIC or MBC less than the bone concentrations. CONCLUSIONS The results of the present study have demonstrated that BPs have an inhibitory effect on selected bacterial species and might inhibit the growth of some relevant pathogens in osteonecrosis. However, most of the species tested were unaffected at the concentration levels assumed present in the human jawbone. The clinical relevance of these in vitro data will better be clarified with reliable data on the BP concentrations in the human jawbone. The present study has provided a first approach toward the assessment of the interaction of oral bacteria and BPs.
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Affiliation(s)
- Michael A Ermer
- Consultant, Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany.
| | - Simon C Kottmann
- Private Practitioner, Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Jörg-Elard Otten
- Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Annette Wittmer
- Medical Technical Assistant, Department of Hygiene and Microbiology, Albert-Ludwigs-Universität, Freiburg, Freiburg, Germany
| | - Philipp Poxleitner
- Resident, Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Klaus Pelz
- Consultant, Department of Hygiene and Microbiology, Albert-Ludwigs-Universität, Freiburg, Freiburg, Germany
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Voss PJ, Matsumoto A, Alvarado E, Schmelzeisen R, Duttenhöfer F, Poxleitner P. Treatment of stage II medication-related osteonecrosis of the jaw with necrosectomy and autologous bone marrow mesenchymal stem cells. Odontology 2017; 105:484-493. [PMID: 28220264 DOI: 10.1007/s10266-017-0295-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 07/07/2016] [Accepted: 12/19/2016] [Indexed: 02/07/2023]
Abstract
Treatment strategies for medication-related osteonecrosis of the jaw (MRONJ) remain controversial. Although the AAOMS suggests a conservative approach, a surgical management with necrosectomy is often required when conservative management has failed. Moreover, recent studies have shown promising results using an early stage surgical treatment. Over the past decade, cell-based bone regeneration utilizing bone marrow mesenchymal stem cells (MSCs) received increased attention. MSCs are known to promote wound healing and induce new bone formation in compromised tissue. Accordingly, the aim of this study was to assess the role of MSCs in the management of MRONJ. This study included 6 patients referred to our department with the diagnosis of MRONJ. Upon informed consent, the patients underwent surgical resection of necrotic bone followed by MSCs grafting. The MSCs were separated from bone marrow cells aspirated from the iliac crest using a bone marrow aspirate concentrate system. The MSCs were grafted into the defect with autologous thrombin and the defect was covered with a collagen membrane. In all cases, bony edges were rounded and the wound was closed using a three-layered technique. In the follow-up from 12 to 54 months, all patients including those who had impaired conditions, sepsis, or pathological fracture, showed satisfactory healing with no signs of wound infection. This pilot study indicated that surgical management in combination with MSCs transplantation seems to be a promising treatment modality in the therapy of MRONJ.
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Affiliation(s)
- Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
| | - Akihiko Matsumoto
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Esteban Alvarado
- Section of Orthodontics and Maxillofacial Surgery, Latinamerican University of Science and Technology, 100 metros sur del Periódico La República, San José, Barrio Tournón, Costa Rica
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
| | - Fabian Duttenhöfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
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Voss P, Ludwig U, Poxleitner P, Bergmaier V, El-Shafi N, von Elverfeldt D, Stadelmann V, Hövener JB, Flügge T. Evaluation of BP-ONJ in osteopenic and healthy sheep: comparing ZTE-MRI with µCT. Dentomaxillofac Radiol 2016; 45:20150250. [PMID: 26846710 DOI: 10.1259/dmfr.20150250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Bisphosphonate-associated osteonecrosis of the jaw (BP-ONJ) is a side effect of antiresorptive treatment that is increasingly prescribed for patients with osteoporosis or malignant diseases with bone metastases. Surgical treatment of BP-ONJ requires adequate pre-operative imaging. To date, CT is the imaging standard in clinical routine; however, defining the extent of the pathological area is difficult and soft tissues are poorly displayed. MRI with zero echo time (ZTE-MRI) to display hard tissues enables a precise display of calcified structures and soft tissues for the delineation of bone necrosis and soft-tissue reactions. METHODS BP-ONJ was induced in eight sheep by extraction of two premolars in the left mandible and zoledronate (ZOL) administration. Eight sheep without ZOL administration served as the control group. Four sheep of each main group underwent osteopenia induction via ovariectomy, glucocorticoid administration and a calcium-free diet. After sacrifice, the area of tooth extraction was harvested and scanned with micro-CT (µCT) and ZTE-MRI. Two trained dentists analyzed digital imaging and communications in medicine data sets using three-dimensional imaging software. The periosteal reaction and the remaining extraction sockets were measured. RESULTS BP-ONJ was evident, and the remaining extraction sockets were observed in all animals treated with ZOL. Periosteal reactions were more pronounced in animals treated with ZOL, and they appeared broader in ZTE-MRI. CONCLUSIONS BP-ONJ lesions in the sheep mandible can be detected using µCT and ZTE-MRI. Although illustration of sequester was more consistent using the µCT, ZTE-MRI was advantageous in evaluation of periosteal reaction.
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Affiliation(s)
- Pit Voss
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Ute Ludwig
- 2 Medical Physics, Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
| | - Philipp Poxleitner
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany.,3 AO Research Institute, Davos, Switzerland
| | - Veronika Bergmaier
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Nora El-Shafi
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Dominik von Elverfeldt
- 2 Medical Physics, Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
| | | | - Jan-Bernd Hövener
- 2 Medical Physics, Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
| | - Tabea Flügge
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
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Voss PJ, Vargas Soto G, Schmelzeisen R, Izumi K, Stricker A, Bittermann G, Poxleitner P. Sinusitis and oroantral fistula in patients with bisphosphonate-associated necrosis of the maxilla. Head Face Med 2016; 12:3. [PMID: 26732879 PMCID: PMC4702393 DOI: 10.1186/s13005-015-0099-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 12/28/2015] [Indexed: 11/12/2022] Open
Abstract
Background The management of bisphosphonate related necrosis of the jaw has become clinical routine. While approximately two thirds of the lesions are in the mandible, one third is located in the maxilla. In 40–50 % of maxillary necrosis the maxillary sinus is involved, leading to maxillary sinusitis and oro-antral communications. Methods This retrospective single center study includes all patients with diagnosis of BP-ONJ of the maxilla and concomitant maxillary sinusitis. The information collected includes age, gender, primary disease, bisphosphonate intake, involving type of bisphosphonate, route of administration and duration of BP treatment previous to surgical treatment and treatment outcome. Results A total of 12 patients fulfill the criteria of the diagnosis of maxillary sinusitis associated to maxillary necrosis, of which 6 Patients showed purulent sinusitis. All patients underwent surgical treatment with complete resection of the affected bone and a multilayer wound closure. A recurrence appeared in one patient with open bone and no sign of sinusitis and was treated conservatively. Conclusions Purulent maxillary Sinusitis is a common complication of bisphosphonate-related necrosis of the maxilla. The surgical technique described can be suggested for the treatment of these patients.
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Affiliation(s)
- Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Medical Center - University of Freiburg , Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany.
| | - Gustavo Vargas Soto
- Department of Oral and Maxillofacial Surgery, Hospital San Juan de Dios, Universidad Latina, San José, Costa Rica
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Medical Center - University of Freiburg , Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
| | - Kiwako Izumi
- Department of Oral and Maxillofacial Surgery, Fukuoka Dental College, Fukuoka, Japan
| | - Andres Stricker
- Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Medical Center - University of Freiburg , Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
| | - Gido Bittermann
- Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Medical Center - University of Freiburg , Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Medical Center - University of Freiburg , Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany
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Bittermann G, Thönissen P, Poxleitner P, Zimmerer R, Vach K, Metzger MC. Microvascular transplants in head and neck reconstruction: 3D evaluation of volume loss. J Craniomaxillofac Surg 2015; 43:1319-24. [DOI: 10.1016/j.jcms.2015.06.013] [Citation(s) in RCA: 13] [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] [Received: 03/26/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022] Open
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Voss PJ, Stoddart M, Ziebart T, Zeiter S, Nelson K, Bittermann G, Schmelzeisen R, Poxleitner P. Zoledronate induces osteonecrosis of the jaw in sheep. J Craniomaxillofac Surg 2015; 43:1133-8. [PMID: 26154396 DOI: 10.1016/j.jcms.2015.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 02/26/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The treatment of bisphosphonate-related osteonecrosis of the jaw has become routine in maxillofacial hospitals. However, the etiopathology has not yet been fully understood. The aim of this study was to develop a large animal model for medication-related osteonecrosis of the jaw (MRONJ). MATERIAL AND METHODS Eight Swiss mountain sheep were randomly assigned into two groups. Group I received 0.075 mg/kg zoledronate (ZOL) intravenously every third week for 16 weeks. After 16 weeks, extraction of the first and second lower left premolar was performed. Group II underwent surgery and no ZOL was administered. After surgery, Group I continued to receive ZOL infusions; after 16 weeks, all animals were euthanized. The jaw bones were investigated macroscopically, radiographically (computed tomography) and histologically. RESULTS Osteonecrosis of the jaw was observed at all extraction sites in all the animals receiving ZOL, and at none of the sites in animals without ZOL. All ZOL-treated animals spontaneously developed exposed bone lesions in the oral cavity at sites where no surgical intervention was performed. CT imaging shows persistent alveolar extraction sockets 16 weeks after surgery in all animals of the ZOL-group, and healed alveolar extraction sockets in non-ZOL-treated animals. CONCLUSION Sheep treated with ZOL reproducibly demonstrated osteonecrosis of the jaw after tooth extraction, and spontaneous development of exposed bone in the oral cavity at sites where no manipulation was performed. This animal model can be used for further research in the fields of BP-ONJ etiopathology, oral implantology, bone and fracture healing and periodontology.
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Affiliation(s)
- Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, (Head: Prof. Dr. R. Schmelzeisen), Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
| | - Martin Stoddart
- AO Research Institute Davos, (Head: Prof. Dr. G. Richards), Clavadeler Str. 8, 7270 Davos Platz, Switzerland.
| | - Thomas Ziebart
- Department of Oral and Maxillofacial Surgery, University Hospital Mainz, (Head: Prof. Dr. W. Wagner), Augustusplatz 2, 55131 Mainz, Germany.
| | - Stephan Zeiter
- AO Research Institute Davos, (Head: Prof. Dr. G. Richards), Clavadeler Str. 8, 7270 Davos Platz, Switzerland.
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, (Head: Prof. Dr. R. Schmelzeisen), Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
| | - Gido Bittermann
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, (Head: Prof. Dr. R. Schmelzeisen), Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, (Head: Prof. Dr. R. Schmelzeisen), Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, (Head: Prof. Dr. R. Schmelzeisen), Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany; AO Research Institute Davos, (Head: Prof. Dr. G. Richards), Clavadeler Str. 8, 7270 Davos Platz, Switzerland.
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Rottke D, Grossekettler L, Sawada K, Poxleitner P, Schulze D. Influence of lead apron shielding on absorbed doses from panoramic radiography. Dentomaxillofac Radiol 2013; 42:20130302. [PMID: 24174012 DOI: 10.1259/dmfr.20130302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study investigated the absorbed doses in a full anthropomorphic body phantom from two different panoramic radiography devices, performing protocols with and without applying a lead apron. METHODS A RANDO(®) full body phantom (Alderson Research Laboratories Inc., Stamford, CT) was equipped with 110 thermoluminescent dosemeters at 55 different sites and set up in two different panoramic radiography devices [SCANORA(®) three-dimensional (3D) (SOREDEX, Tuusula, Finland) and ProMax(®) 3D (Planmeca, Helsinki, Finland)] and exposed. Two different protocols were performed in the two devices. The first protocol was performed without any lead shielding, whereas the phantom was equipped with a standard adult lead apron for the second protocol. RESULTS A two-tailed paired samples t-test for the SCANORA 3D revealed that there is no difference between the protocol using lead apron shielding (m = 87.99, s = 102.98) and the protocol without shielding (m = 87.34, s = 107.49), t(54) = -0.313, p > 0.05. The same test for the ProMax 3D showed that there is also no difference between the protocol using shielding (m = 106.48, s = 117.38) and the protocol without shielding (m = 107.75, s = 114,36), t(54) = 0.938, p > 0.05. CONCLUSIONS In conclusion, the results of this study showed no statistically significant differences between a panoramic radiography with or without the use of lead apron shielding.
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Affiliation(s)
- D Rottke
- Dental Diagnostic Center, Freiburg, Germany
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Voss P, Vargas G, Poxleitner P, Bittermann G, Metzger M, Schmelzeisen R. Surgical treatment of bisphosphonate-associated necrosis of the maxilla with concomitant sinusitis. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.082] [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: 11/15/2022]
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Abstract
OBJECTIVES Evaluation and reduction of dose are important issues. Since cone beam CT (CBCT) has been established now not just in dentistry, the number of acquired examinations continues to rise. Unfortunately, it is very difficult to compare the doses of available devices on the market owing to different exposition parameters, volumes and geometries. The aim of this study was to evaluate the spans of effective doses (EDs) of ten different CBCT devices. METHODS 48 thermoluminescent dosemeters were placed in 24 sites in a RANDO(®) head phantom. Protocols with lowest exposition parameters and protocols with highest exposition parameters were performed for each of the ten devices. The ED was calculated from the measured energy doses according to the International Commission on Radiological Protection 2007 recommendations for each protocol and device, and the statistical values were evaluated afterwards. RESULTS The calculation of the ED resulted in values between 17.2 µSv and 396 µSv for the ten devices. The mean values for protocols with lowest and highest exposition parameters were 31.6 µSv and 209 µSv, respectively. CONCLUSIONS It was not the aim of this study to evaluate the image quality depending on different exposition parameters but to define the spans of EDs in which different CBCT devices work. There is a wide span of ED for different CBCT devices depending on the selected exposition parameters, required spatial resolution and many other factors.
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Affiliation(s)
- D Rottke
- Dental Diagnostic Center, 79098 Freiburg, Germany.
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Rottke D, Grossekettler L, Sawada K, Poxleitner P, Schulze D. Influence of lead apron shielding on absorbed doses from panoramic radiography. Dentomaxillofac Radiol 2013; 42:20130302. [PMID: 24404601] [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] Open
Abstract
OBJECTIVES This study investigated the absorbed doses in a full anthropomorphic body phantom from two different panoramic radiography devices, performing protocols with and without applying a lead apron. METHODS A RANDO® full body phantom (Alderson Research Laboratories Inc., Stamford, CT) was equipped with 110 thermoluminescent dosemeters at 55 different sites and set up in two different panoramic radiography devices [SCANORA® three-dimensional (3D) (SOREDEX, Tuusula, Finland) and ProMax® 3D (Planmeca, Helsinki, Finland)] and exposed. Two different protocols were performed in the two devices. The first protocol was performed without any lead shielding, whereas the phantom was equipped with a standard adult lead apron for the second protocol. RESULTS A two-tailed paired samples t-test for the SCANORA 3D revealed that there is no difference between the protocol using lead apron shielding (m = 87.99, s = 102.98) and the protocol without shielding (m = 87.34, s = 107.49), t(54) = −0.313, p > 0.05. The same test for the ProMax 3D showed that there is also no difference between the protocol using shielding (m = 106.48, s = 117.38) and the protocol without shielding (m = 107.75, s = 114,36), t(54) = 0.938, p > 0.05. CONCLUSIONS In conclusion, the results of this study showed no statistically significant differences between a panoramic radiography with or without the use of lead apron shielding.
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