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Tolksdorf K, Schultze-Mosgau S, Jacobs C, Tietz S, Hennig CL. Orthognathic Surgery with Interdisciplinary Digital Planning in Patients with Geroderma Osteodysplasticum: A Case Report. J Pers Med 2023; 13:1578. [PMID: 38003893 PMCID: PMC10672396 DOI: 10.3390/jpm13111578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/27/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with geroderma osteodysplasticum (GO) often times have dentofacial deformities and benefit from orthognathic surgery. Because of generalized osteopenia, operations must be prepared even more meticulously than usual, and the higher risk of unfortunate fractures (bad splits) should be explained to the patients in detail. This case report is intended to portray a digital, interdisciplinary and patient-individualized planning of orthognathic surgery. It points out the individual steps that must be considered and how they can be advantageously used in patients with underlying diseases or syndromes such as GO. Through a careful digital representation of the surgical options, production of the digitally modeled splints, 3D printing and good manual surgical implementation, the quality of life of patients with GO can be increased through orthognathic surgery. Both the functions in the oral, maxillofacial region and the patient's appearance in the case presented here benefited from the interdisciplinary, individualized and digital treatment approach.
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Affiliation(s)
- Konrad Tolksdorf
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Stefan Schultze-Mosgau
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Collin Jacobs
- Department of Orthodontics, Center of Dental Medicine, Jena University Hospital, An der Alten Post 4, 07743 Jena, Germany
| | - Stephanie Tietz
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Christoph-Ludwig Hennig
- Department of Orthodontics, Center of Dental Medicine, Jena University Hospital, An der Alten Post 4, 07743 Jena, Germany
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Kouka M, Landgraf J, Büntzel J, Kaftan H, Böger D, Mueller A, Schultze-Mosgau S, Ernst T, Guntinas-Lichius O. [Mortality risk for oral and oropharyngeal carcinomas in Thuringia: a population-based analysis]. Laryngorhinootologie 2023. [PMID: 36603817 DOI: 10.1055/a-1976-9815] [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: 01/07/2023]
Abstract
OBJECTIVE This population-based study investigates the impact of HPV association on overall survival (OS) of oral cavity (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC) in Thuringia and the incidence of HPV-positive (HPV+) and HPV-negative (HPV-) tumors. METHODS A total of 308 patients (83.4% men; mean age 57.6 years) with a primary diagnosis of OSCC (38%) or OPSCC (62%) from 2008 were included in the study. Descriptive statistics were obtained for the variables. According to Ang's risk classification, patients were classified as low risk of death (HPV+, nonsmokers), intermediate risk (HPV+, smokers) and high risk of death (HPV-) smokers). Kaplan-Meier analyses and Cox multivariable regression analysis were performed to examine OS. RESULTS 22.5% of OPSCC was HPV+ (incidence: 1.89/100,000 population; thereof 80.1% smokers). The proportion of OSCC with HPV+ was 8.5% (incidence: 0.44/100,000; thereof 78.6% smokers). The median follow-up was 31 months. HPV+ patients had significantly better 5-year OS than HPV- patients (81% vs. 49%; p < 0.001). In multivariable analysis lower OS were associated with: HPV- patients (hazard ratio (HR) = 3.2; 95% confidence interval (CI) = 1.6 - 6.4; p = 0.001), high risk of death according to Ang (HR = 2.3; 95% CI = 1.0 - 5.4; p = 0.049), older age (HR = 1.7; 95% CI = 1.1 - 2.4; p = 0.01), T3/T4-classification (HR = 2.1; 95% CI = 1.3 - 3.2; p = 0.001) and the presence of distant metastases (HR = 2.7; 95% CI = 1.6-4.4; p < 0.001). CONCLUSIONS HPV+ non-smokers were minority in Thuringia. The majority of HPV+ patients had an intermediate risk of death due to cigarette smoking.
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Affiliation(s)
- Mussab Kouka
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Josefin Landgraf
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Jens Büntzel
- HNO-Klinik, Südharz Klinikum Nordhausen gGmbH, Nordhausen, Germany
| | | | | | - Andreas Mueller
- Klinik für HNO-Heilkunde/Plastische Operationen, SRH Wald-Klinikum Gera GmbH, Gera, Germany
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Jena, Germany
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Kouka M, Buentzel J, Kaftan H, Boeger D, Mueller AH, Wittig A, Schultze-Mosgau S, Ernst T, Guntinas-Lichius O. Early Mortality among Patients with Head and Neck Cancer Diagnosed in Thuringia, Germany, between 1996 and 2016—A Population-Based Study. Cancers (Basel) 2022; 14:cancers14133099. [PMID: 35804871 PMCID: PMC9264998 DOI: 10.3390/cancers14133099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 12/24/2022] Open
Abstract
Population-based studies on early mortality in head and neck cancer (HNC) are sparse. This retrospective population-based study investigated early mortality of HNC and the influence of patients’ tumor and treatment characteristics. All 8288 patients with primary HNC of the German federal state Thuringia from 1996 to 2016 were included. Univariate and multivariate analysis were performed to identify independent factors for 30-day, 90-day, and 180-day mortality. The 30-, 90-, and 180-day mortality risks were 1.8%, 5.1%, and 9.6%, respectively. In multivariable analysis, male sex (odds ratio (OR) 1.41; 95% confidence interval (CI) 1.08–1.84), increasing age (OR 1.81; CI 1.49–2.19), higher T (T4: OR 3.09; CI 1.96–4.88) and M1 classification (OR 1.97; CI 1.43–2.73), advanced stage (IV: OR 3.97; CI 1.97–8.00), tumors of the cavity of mouth (OR 3.47; CI 1.23–9.75), oropharynx (OR 3.01; CI 1.06–8.51), and hypopharynx (OR 3.27; CI 1.14–9.40) had a significantly greater 180-day mortality. Surgery (OR 0.51; CI 0.36–0.73), radiotherapy (OR 0.37; CI 0.25–0.53), and multimodal therapy (OR 0.10; CI 0.07–0.13) were associated with decreased 180-day mortality. Typical factors associated with worse overall survival had the most important impact on early mortality in a population-based setting.
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Affiliation(s)
- Mussab Kouka
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany;
| | - Jens Buentzel
- Department of Otorhinolaryngology, Suedharzklinikum Nordhausen, 99734 Nordhausen, Germany;
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, 99089 Erfurt, Germany;
| | - Daniel Boeger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, 98527 Suhl, Germany;
| | - Andreas H. Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, 07548 Gera, Germany;
| | - Andrea Wittig
- Department of Radiotherapy and Radiation Oncology, Jena University Hospital, 07743 Jena, Germany;
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, 07747 Jena, Germany;
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, 07747 Jena, Germany;
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany;
- Correspondence: ; Tel.: +49-3641-9329301; Fax: +49-3641-9329302
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Kouka M, Engelhardt M, Wittig A, Schultze-Mosgau S, Ernst T, Guntinas-Lichius O. No impact of time to treatment initiation for head and neck cancer in a tertiary university center in 2003, 2008 and 2013. Eur Arch Otorhinolaryngol 2022; 279:4549-4560. [PMID: 35488907 PMCID: PMC9363340 DOI: 10.1007/s00405-022-07392-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
Background This retrospective study investigated factors influencing time to treatment initiation (TTI) and the influence of TTI on overall survival (OS) of primary head and neck cancer (HNC) patients in cohorts from 2003, 2008 and 2013. Methods Two hundred and ninenty seven patients (78.8% men; median age: 62 years) were included. Kaplan–Meier analyses and multivariate Cox regression were performed to investigate OS. Results Mean times to treatment initiation (TTI) of 2003, 2008 and 2013 were 17.11 ± 18.00, 30.26 ± 30.08 and 17.30 ± 37.04 days, respectively. TTI for patients with T3/T4 tumors was higher than for T1/T2 (p = 0.010). In univariable analysis on OS, TTI > 5 days showed lower OS (p = 0.047). In multivariate analysis, longer TTI had no influence on lower OS [hazard ratio (HR) 1.236; 95% CI 0.852–1.791; p = 0.264], but male gender [HR 2.342; 95% CI 1.229–4.466; p = 0.010], increased age [HR 1.026; 95% CI 1.008–1.045; p = 0.005], M1 [HR 5.823; 95% CI 2.252–15.058; p = 0.003], hypopharynx tumor [HR 2.508; 95% CI 1.571–4.003; p < 0.001] and oral cavity tumor [HR 1.712; CI 1.101–2.661; p = 0.017]. The year of treatment showed no significant effect on OS. Conclusion Median TTI seemed to be very short compared to other studies. There was no clear trend in the impact of TTI on OS from 2003 to 2013. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-022-07392-w.
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Affiliation(s)
- Mussab Kouka
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Max Engelhardt
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Andrea Wittig
- Department of Radiotherapy and Radiation Oncology, Jena University Hospital, Jena, Germany
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Wolfer S, Kunzler A, Foos T, Ernst C, Leha A, Schultze-Mosgau S. Gender and risk-taking behaviors influence the clinical presentation of oral squamous cell carcinoma. Clin Exp Dent Res 2022; 8:141-151. [PMID: 34989151 PMCID: PMC8874093 DOI: 10.1002/cre2.523] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 11/26/2021] [Accepted: 12/18/2021] [Indexed: 12/24/2022] Open
Abstract
Objective The common risk factors for oral squamous cell carcinoma (OSCC) are smoking and alcohol abuse. A small percentage of patients, mostly women, are demonstrating oral cancer without the common risk behavior. This study investigates how gender and different patterns of lifestyle factors influence the clinical presentation of OSCC. Patients and Methods From this retrospective study, demographical and tumor‐specific data and lifestyle factors were analyzed. Statistical analyses were performed using the χ2 test or Fisher's exact test for categorical analysis and the t test, ANOVA test, or Kruskal–Wallis test for continuous variables. The influence of the respective lifestyle factors together with their interactions with the gender on tumor characteristics has been tested using logistic and ordinal cumulative link regression models. Results Among a total of 308 patients, men represented the majority of smokers (87.2%) and the female cohort were largely non‐smokers and non‐drinkers (64.9%). For age, tumor site and N‐stage it looks like that differences of men and women are driven by the different risk behavior. But if the lifestyle factors are taken into account, we observe contrary effects between men and women for T‐, N‐, and UICC‐stage. For different cancer locations we saw opposite effects with gender and risk profile. These effects are not dose‐dependent explainable for gender. Conclusion Some but not all differences in the development of OSCC for men and women are explainable by the respective difference in lifestyle behavior. Some further investigations are necessary to find explanations for the obvious differences between men and women in developing OSCC.
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Affiliation(s)
- Susanne Wolfer
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Annika Kunzler
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Tatjana Foos
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Cornelia Ernst
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Andreas Leha
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Stefan Schultze-Mosgau
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Jena, Germany
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Kouka M, Al-Ahmar E, Büntzel J, Kaftan H, Böger D, Müller A, Schultze-Mosgau S, Ernst T, Guntinas-Lichius O. The log odds of positive neck lymph nodes is a superior lymph node predictor for overall survival in head and neck cancer: a population-based analysis in Germany. Eur Arch Otorhinolaryngol 2021; 279:3587-3595. [PMID: 34807283 PMCID: PMC9130179 DOI: 10.1007/s00405-021-07176-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This population-based study investigated the influence of different lymph node (LN) classifications on overall survival (OS) in head and neck cancer (HNC). METHODS 401 patients (median age: 57 years; 47% stage IV) of the Thuringian cancer registries with diagnosis of a primary HNC receiving a neck dissection (ND) in 2009 and 2010 were included. OS was assessed in relation to total number of LN removed, number of positive LN, LN ratio, and log odds of positive LN (LODDS). RESULTS Mean number of LODDS was 0-0.96 ± 0.57. When limiting the multivariate analysis to TNM stage, only the UICC staging (stage IV: HR 9.218; 95% CI 2.721-31.224; p < 0.001) and LODDS > - 1.0 (HR 2.120; 95% CI 1.129-3.982; p = 0.019) were independently associated with lower OS. CONCLUSION LODDS was an independent and superior predictor for OS in HNC in a population-based setting with representative real-life data.
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Affiliation(s)
- Mussab Kouka
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Elisa Al-Ahmar
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Jens Büntzel
- Department of Otorhinolaryngology, Suedharzklinikum Nordhausen, Nordhausen, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Daniel Böger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Andreas Müller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Thielker J, Wahdan A, Buentzel J, Kaftan H, Boeger D, Mueller AH, Wittig A, Schultze-Mosgau S, Ernst T, Guntinas-Lichius O. Long-Term Facial Nerve Outcome in Primary Parotid Cancer Surgery: A Population-Based Analysis. Laryngoscope 2021; 131:2694-2700. [PMID: 34050959 DOI: 10.1002/lary.29666] [Citation(s) in RCA: 3] [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: 04/05/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS To determine immediate postoperative and long-term facial nerve dysfunction after parotid cancer surgery, risk factors, and the role of facial reanimation surgery. STUDY DESIGN Population-based long-term analysis for all new primary parotid carcinoma cases in Thuringia from 1996 to 2019. METHODS Data of the cancer registries of Thuringia, a federal state in Germany, were analyzed in combination with hospital-based data on facial function. RESULTS About 477 patients (42.3% women; median age: 68 years) were included. It was observed that 6.7% had a preoperative facial nerve dysfunction, 11.7% received a radical parotidectomy, that is, that 5% had a normal preoperative facial function but needed radical surgery because of intraoperative detection of tumor infiltration into the facial nerve. About 10.2% received facial nerve reconstruction surgery. Immediate postoperative facial nerve dysfunction in the other patients was observed in 34.4% of the patients. Advanced T classification (odds ratio [OR] = 2.140; confidence interval [CI] = 1.268-3.611; P = .004) and neck dissection (OR = 2.012; CI = 1.027-3.940; P = .041) were independent risk factors for immediate postoperative facial nerve dysfunction. In addition, 22.0% showed no recovery during follow-up. Advanced T classification (OR = 2.177; CI = 1.147-4.133; P = .017) and postoperative radiotherapy (OR = 2.695; CI = 1.244-5.841; P = .012) were independent risk factors for permanent postoperative facial nerve dysfunction. CONCLUSION Patients with primary parotid cancer are at high risk for long-term facial nerve dysfunction. It seems that the possibilities of facial reanimation surgery needs to be utilized even more effectively. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Jovanna Thielker
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Ali Wahdan
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Suedharzklinikum Nordhausen, Nordhausen, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Andreas H Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Andrea Wittig
- Department of Radiotherapy and Radiation Oncology, Jena University Hospital, Jena, Germany
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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Dittberner A, Friedl B, Wittig A, Buentzel J, Kaftan H, Boeger D, Mueller AH, Schultze-Mosgau S, Schlattmann P, Ernst T, Guntinas-Lichius O. Gender Disparities in Epidemiology, Treatment, and Outcome for Head and Neck Cancer in Germany: A Population-Based Long-Term Analysis from 1996 to 2016 of the Thuringian Cancer Registry. Cancers (Basel) 2020; 12:cancers12113418. [PMID: 33218009 PMCID: PMC7698743 DOI: 10.3390/cancers12113418] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Head and neck cancer (HNC) comprises a heterogeneous group of cancers. Not much population-based data has been published on gender disparities related to the incidences between different age groups, subsites, tumor stages, and its effect on therapy decisions. All new HNC cases from Thuringia between 1996 and 2016 were analyzed. The incidence of head and neck cancer still was 4-fold higher in men compared to women. Incidence reached a peak for men between 60–64 years, where the incidence increased with older age in women. Male gender, higher tumor stage and subsite (worst: hypopharyngeal cancer) still had a major negative impact on the survival of the patients. Treatment decisions were different between male and female patients, especially in older patients with a tendency to less aggressive therapy. Putting all patients together, there probably was no improvement in survival beyond changes in treatment over the observation period from 1996 to 2016. Abstract This study determined with focus on gender disparity whether incidence based on age, tumor characteristics, patterns of care, and survival have changed in a population-based sample of 8288 German patients with head neck cancer (HNC) registered between 1996 and 2016 in Thuringia, a federal state in Germany. The average incidence was 26.13 ± 2.89 for men and 6.23 ± 1.11 per 100,000 population per year for women. The incidence peak for men was reached with 60–64 years (63.61 ± 9.37). Highest incidence in females was reached at ≥85 years (13.93 ± 5.87). Multimodal concepts increased over time (RR = 1.33, CI = 1.26 to 1.40). Median follow-up time was 29.10 months. Overall survival (OS) rate at 5 years was 48.5%. The multivariable analysis showed that male gender (Hazard ratio [HR] = 1.44; CI = 1.32 to 1.58), tumor subsite (worst hypopharyngeal cancer: HR = 1.32; CI = 1.19 to 1.47), and tumor stage (stage IV: HR = 3.40; CI = 3.01 to 3.85) but not the year of diagnosis (HR = 1.00; CI = 0.99 to 1.01) were independent risk factors for worse OS. Gender has an influence on incidence per age group and tumor subsite, and on treatment decision, especially in advanced stage and elderly HNC patients.
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Affiliation(s)
- Andreas Dittberner
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (A.D.); (B.F.)
| | - Benedikt Friedl
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (A.D.); (B.F.)
| | - Andrea Wittig
- Department of Radiotherapy and Radiation Oncology, Jena University Hospital, 07747 Jena, Germany;
| | - Jens Buentzel
- Department of Otorhinolaryngology, Südharz Klinikum Nordhausen, 99734 Nordhausen, Germany;
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, 99089 Erfurt, Germany;
| | - Daniel Boeger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, 98527 Suhl, Germany;
| | - Andreas H. Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, 07548 Gera, Germany;
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, 07747 Jena, Germany;
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, 07747 Jena, Germany;
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, 07747 Jena, Germany;
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (A.D.); (B.F.)
- Correspondence: ; Tel.: +49-3641-9329301; Fax: +49-3641-9329302
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9
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Wolfer S, Wohlrath R, Kunzler A, Foos T, Ernst C, Schultze-Mosgau S. Scapular free flap as a good choice for mandibular reconstruction: 119 out of 280 cases after resection of oral squamous cell carcinoma in a single institution. Br J Oral Maxillofac Surg 2020; 58:451-457. [PMID: 32201048 DOI: 10.1016/j.bjoms.2020.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 02/25/2020] [Indexed: 11/16/2022]
Abstract
Microsurgical procedures for reconstruction after resection of head and neck tumours have become standardised and reliable. Among them, the scapular free flap is used less often, mostly to avoid excessive operating times. We hypothesise that complex reconstructions after resection of oral squamous cell carcinoma (OSCC) are successful even with time-consuming free flaps such as the scapular free flap. In this retrospective, single-centre study, we used the evaluation of medical records to investigate the postoperative outcome of microvascular reconstruction after ablative surgery of OSCC. Associations among the categorical variables were analysed using Pearson's chi squared test or Fisher's exact test. Among the continuous variables, the t test or Mann-Whitney U test were used as appropriate. For multivariate analysis, the logistic regression model was calculated. In the sample of 280 free flap reconstructions, we performed 142 radial forearm and 119 scapular free flaps. The American Society of Anesthesiology (ASA) score (p=0.006) and the duration of the operation (p=0.010) are independent factors which influence the need for operative revisions. The type of free flap is irrelevant for that. With 4.2% flap losses, scapular free flaps were successful; even in patients ≥ 70 years old (0 flap losses). Complex reconstructions after surgical resection of OSCC are successful even in aged patients. The scapular free flap is a good choice for mandibular reconstruction despite the time-consuming intraoperative repositioning of the patient. In an increasingly ageing group of patients, who have more vascular diseases, scapular free flaps could be a very successful alternative after ablative surgery of oral squamous cell carcinoma.
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Affiliation(s)
- S Wolfer
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - R Wohlrath
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - A Kunzler
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - T Foos
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - C Ernst
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - S Schultze-Mosgau
- Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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Schultze-Mosgau S. Flapless surgery and peri-implant late-stage inflammation and healing. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.152] [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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11
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Wolfer S, Foos T, Kunzler A, Ernst C, Schultze-Mosgau S. Association of the Preoperative Body Mass Index With Postoperative Complications After Treatment of Oral Squamous Cell Carcinoma. J Oral Maxillofac Surg 2018; 76:1800-1815. [PMID: 29605536 DOI: 10.1016/j.joms.2018.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 02/23/2018] [Accepted: 02/24/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Nutritional status is believed to influence surgical outcome. Because of a lack of actual reports in the literature, this study evaluated the surgical outcome of patients after treatment for oral squamous cell carcinoma (OSCC), with special focus on the preoperative body mass index (BMI). PATIENTS AND METHODS This retrospective cohort study investigated the association between preoperative BMI and surgical outcome for patients with OSCC, focusing on local and medical complications. This research also analyzed common clinical and demographic parameters, such as age, gender, TNM stage, tumor differentiation, risk behavior, Karnofsky Index, duration of operation, and length of hospital stay. Statistics were performed using the χ2 test or Fisher exact test for categorical analysis and the t test or analysis of variance and Pearson correlation test for continuous variables. Multivariate analysis was computed for BMI with a multivariate linear regression model and for local and medical complications with multivariate Poisson regression. RESULTS In the sample of 419 patients with OSCC, 8.6% were underweight, 54.7% were normal weight, and 36.8% were overweight (overall mean BMI, 24.28 kg/m2). BMI was significantly associated with age (P = .0017), consumption of nicotine (P = .0178) and alcohol (P = .0008), dental status (P = .0163), tumor differentiation (P = .0288), and tumor status (P = .0005). Underweight in particular was negatively correlated with local postoperative complications (P = .0047). Local complications were associated with the need for operative revisions (P < .0001) and an increase of hospital length of stay (P < .0001) using multivariable analysis. CONCLUSION These results indicate that evaluation of preoperative morbidity and nutritional status, especially in underweight patients, is worthwhile to improve medical and economic postoperative outcomes after surgical therapy of OSCC.
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Affiliation(s)
- Susanne Wolfer
- Specialist, Department of Oral and Maxillofacial and Plastic Surgery, Jena University Hospital, Jena, Germany.
| | - Tatjana Foos
- Dentist, Department of Oral and Maxillofacial and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Annika Kunzler
- Student of Dental Medicine, Department of Oral and Maxillofacial and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Cornelia Ernst
- Resident, Department of Oral and Maxillofacial and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Stefan Schultze-Mosgau
- Professor and Head of Department, Department of Oral and Maxillofacial and Plastic Surgery, Jena University Hospital, Jena, Germany
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Wolfer S, Elstner S, Schultze-Mosgau S. Degree of Keratinization Is an Independent Prognostic Factor in Oral Squamous Cell Carcinoma. J Oral Maxillofac Surg 2017; 76:444-454. [PMID: 28738193 DOI: 10.1016/j.joms.2017.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE Keratinization is a routinely reported histologic feature in head and neck cancer. In contrast to numerous clinicopathologic parameters, the prognostic value of keratinization in oral squamous cell carcinoma (OSCC) is rarely reported in the literature. The purpose of this study was to review the outcome of patients with OSCC with a special focus on the degree of keratinization. PATIENTS AND METHODS In this retrospective cohort study, we evaluated the medical records at the Department of Oral and Maxillofacial Surgery, Jena University Hospital, and investigated the outcome of patients with OSCC with disease-free survival and disease-specific survival according to the degree of keratinization. This research also analyzed common clinical and histologic parameters such as age, gender, tumor site, T category, N category, resection margin, lymphovascular invasion, and extracapsular spread. Descriptive statistics were performed, and survival was calculated by the Kaplan-Meier method. Prognostic factors were analyzed by multivariate Cox analysis. RESULTS In the sample of 151 OSCC patients, with a median age of 57.5 years and a male-female ratio of 4.03:1, 119 had tumors with no or low keratinization (K0 to K2) and 32 had tumors with good or high keratinization (K3 or K4). More recurrences were seen in patients with OSCC with low keratinization (P = .0008). The 5-year disease-free survival rate was significantly decreased for OSCC with low keratinization (52.9%) compared with good or high keratinization (93.2%) (P = .0008). The 5-year disease-specific survival rate was reduced to 66.1% (P = .0136) for patients with OSCC with low keratinization. Multivariate analysis showed that extracapsular spread (P = .001) and keratinization (P = .002) are independent, significant prognostic factors for recurrence in OSCC. CONCLUSIONS Besides extracapsular spread, the degree of keratinization seems to be an important prognostic factor for recurrence and survival in OSCC. Our results indicate that the degree of keratinization should be considered in decisions regarding treatment and prognosis for OSCC.
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Affiliation(s)
- Susanne Wolfer
- Specialist, Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Jena, Germany.
| | - Stefan Elstner
- Private Practitioner, Medical Office of Oral and Maxillofacial Surgery, Ilmenau, Germany
| | - Stefan Schultze-Mosgau
- Professor and Head of Department, Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Jena, Germany
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Peisker A, Raschke GF, Fahmy MD, Guentsch A, Roshanghias K, Hennings J, Schultze-Mosgau S. Salivary MMP-9 in the detection of oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal 2017; 22:e270-275. [PMID: 28160595 PMCID: PMC5432074 DOI: 10.4317/medoral.21626] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/06/2016] [Indexed: 11/19/2022] Open
Abstract
Background Oral squamous cell carcinoma (OSCC) is the most common malignant tumour of the oral cavity. Detection of OSCC is currently based on clinical oral examination combined with histopathological evaluation of a biopsy sample. Direct contact between saliva and the oral cancer makes measurement of salivary metalloproteinase- 9 (MMP-9) an attractive alternative. Material and Methods In total, 30 OSCC patients and 30 healthy controls were included in this prospective study. Saliva samples from both groups were collected, centrifuged and supernatant fluid was subjected to ELISA for assessment of MMP-9. The median salivary MMP-9 values with interquartile range (IQR) of OSCC patients and the control group were statistically analysed using the Mann-Whitney U-test. The receiver operating characteristic (ROC) curve was constructed and the area under curve (AUC) was computed. Results The median absorbance MMP-9 value of the OSCC group was 0.186 (IQR=0.158) and that of control group was 0.156 (IQR=0.102). MMP-9 was significantly increased in the OSCC patients than in the controls by +19.2% (p=0.008). Median values in patients with recurrence and in patients with primary event were 0.233 (IQR=0.299) and 0.186 (IQR=0.134) respectively. MMP-9 was significantly increased in patients with primary event (p=0.017) compared to controls by +19.2%. No significant increase of MMP-9 level was detected when comparing patients with recurrence and healthy controls (+49.4%; p=0.074). The sensitivity value of MMP-9 was 100% whereas the specificity value was 26.7% with AUC of 0.698. Conclusions The present data indicates that the elevation of salivary levels of MMP-9 may be a useful adjunctive diagnostic tool for detection of OSCC. However, further studies are necessary to provide scientific and clinical validation. Key words:Oral squamous cell carcinoma, oral cancer, saliva, salivary diagnostics, cancer detection, MMP-9, metalloproteinases.
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Affiliation(s)
- A Peisker
- Department of Cranio-Maxillofacial & Plastic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany,
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14
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Raschke GF, Meissner W, Peisker A, Djedovic G, Rieger U, Guentsch A, Dammeier MG, Schultze-Mosgau S. Bilateral sagittal split osteotomy-parameters and correlations of postoperative pain management. Clin Oral Investig 2017; 22:181-187. [PMID: 28293792 DOI: 10.1007/s00784-017-2097-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Postoperative pain management is of utmost interest for patients undergoing orthognathic surgery. Currently, there is a lack of information regarding process and outcome parameters of postoperative pain management after bilateral sagittal split osteotomy. MATERIALS AND METHODS In a prospective clinical study, 31 adults were evaluated on the first postoperative day following bilateral sagittal split osteotomy using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It allows a standardized assessment of patients' characteristics, pain parameters, outcome, and pain therapy process parameters. RESULTS Pain management consisted mainly of premedication with midazolam, sufentanil, and metamizol intraoperatively; piritramide in the recovery room; and metamizol and tramadol on ward. Twenty patients (64.5%) showed inadequate pain management with pain levels ≥4. Patients receiving tramadol as opioid on ward presented significantly higher maximum pain levels (p = .037). Significantly lower satisfaction with postoperative pain intensity (p > .001) and significantly higher desire for additional pain medication (p = .023) were detected, when duration of surgery was above the median of 107.5 min. CONCLUSIONS Inadequate pain management on the first postoperative day following bilateral sagittal split osteotomy was widespread on our ward. QUIPS helped us to identify it and thereby gave us the possibility to improve the situation. Prolonged duration of surgery seems to be a predictor of an elevated postoperative pain medication demand. CLINICAL RELEVANCE Only the establishment of an ongoing monitoring of postoperative pain management can help to reduce or even avoid inadequate postoperative pain management. In accordance to the existing literature, we found inadequate postoperative pain management more widespread than thought.
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Affiliation(s)
- Gregor F Raschke
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
| | - Winfried Meissner
- Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Andre Peisker
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Gabriel Djedovic
- Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany.,Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria
| | - Ulrich Rieger
- Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany
| | - Arndt Guentsch
- Marquette University School of Dentistry, Milwaukee, WI, USA
| | - Marta Gomez Dammeier
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Stefan Schultze-Mosgau
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
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Schultze-Mosgau S. Free flap reconstruction following ablative tumour surgery — donor-site morbidity and quality of life. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.651] [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: 10/19/2022]
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Göllnitz I, Inhestern J, Wendt TG, Buentzel J, Esser D, Böger D, Mueller AH, Piesold JU, Schultze-Mosgau S, Eigendorff E, Schlattmann P, Guntinas-Lichius O. Role of comorbidity on outcome of head and neck cancer: a population-based study in Thuringia, Germany. Cancer Med 2016; 5:3260-3271. [PMID: 27726294 PMCID: PMC5119982 DOI: 10.1002/cam4.882] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 07/02/2016] [Accepted: 08/02/2016] [Indexed: 12/21/2022] Open
Abstract
To examine the impact of comorbidity on overall survival (OS) in a population‐based study of patients with head and neck cancer who were treated between 2009 and 2011. Data of 1094 patients with primary head and neck carcinomas without distant metastasis from the Thuringian cancer registries were evaluated concerning the influence of patient's characteristics and comorbidity on OS. Data on comorbidity prior to head and neck cancer diagnosis was adapted to the Charlson Comorbidity (CCI), age‐adjusted CCI (ACCI), head and neck CCI (HNCCI), simplified comorbidity score (SCS), and to the Adult Comorbidity Evaluation–27 (ACE‐27). Most patients were male (80%; median age: 60 years; 50% stage IV tumors). Smoking, alcohol abuse, and anemia were registered for 38%, 33%, and 23% of the patients, respectively. Predominant therapy was surgery + radiochemotherapy (30%), surgery (29%), and surgery + radiotherapy (21%). Mean CCI, ACCI, HNCCI, SCS and ACE‐27 were 1.0 ± 1.5, 2.6 ± 2.1, 0.6 ± 0.8, 4.4 ± 4.2, and 0.9 ± 0.9, respectively. Median follow‐up was 25.7 months. Multivariable analyses showed that higher age, higher UICC stage, no therapy, including surgery or radiotherapy, alcohol abuse, and anemia, higher comorbidity were independent risk factors for worse OS (all P < 0.05). According to the discriminatory power analysis none of the five comorbidity scores was superior to the other scores to prognosticate OS. This population‐based study showed that comorbidity is frequent in German patients with head and neck cancer and is an important risk factor for poor OS. Comorbidity should be routinely assessed and taken into account in prospective clinical trials.
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Affiliation(s)
- Irene Göllnitz
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Johanna Inhestern
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Thomas G Wendt
- Department of Radiooncology, Jena University Hospital, Jena, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Suedharzkrankenhaus Nordhausen, Nordhausen, Germany
| | - Dirk Esser
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Daniel Böger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Andreas H Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Jörn-Uwe Piesold
- Department of Oromaxillofacial Surgery, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, Jena, Germany
| | | | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
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Raschke GF, Eberl P, Thompson GA, Güntsch A, Peisker A, Schultze-Mosgau S, Gomez-Dammeier M, Djedovic G, Rieger UM, Beuer F. Wearing complete dental prostheses - Effects on perioral morphology. Med Oral Patol Oral Cir Bucal 2016; 21:e413-9. [PMID: 27031069 PMCID: PMC4920453 DOI: 10.4317/medoral.21102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/15/2016] [Indexed: 12/05/2022] Open
Abstract
Background To adequately perform rehabilitation of edentulous patients by a complete removable dental prosthesis (CRDP) is from basic interest to dentists to understand the morphologic changes caused by re-establishment of a physiologic jaw relationship. Anthropometric analyses of standardized frontal view and profile photographs may help elucidate such changes. Material and Methods Photographs of 31 edentulous patients were compared in relaxed lip closure and after insertion of a CRDP in stable occlusion. 2232 anthropometric distances were raised. Eighteen anthropometric indices reflecting the perioral morphology and its integration in the vertical facial harmony were investigated. Results The intercanthal – mouth width index (p<.001), medial - lateral cutaneous upper lip height index (p=.007), lower vermilion contour index (p=.022), vermilion - total upper lip height index (p=.018), cutaneous - total upper lip height index (p=.023), upper lip - nose height index (p=.001), nose - upper face height index (p=.002), chin - mandible height index (p=.013), upper lip - mandible height index (p=.045), nose - lower face height index (p=.018), and nose - face height index (p=.029) showed significant pre- to post-treatment changes. Conclusions The investigated anthropometric indices presented reproducible results related to an increase in occlusal vertical dimension. Their application may be helpful in assessment, planning, and explanation of morphologic effects of CRDPs on the perioral and overall facial morphology, which may helps to improve the aesthetic outcome. Key words:Dentures, removable dentures, anthropometry, perioral morphology.
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Affiliation(s)
- G-F Raschke
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Universitätsklinikum Jena, D-07747 Jena, Germany,
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Peisker A, Raschke GF, Guentsch A, Roshanghias K, Eichmann F, Schultze-Mosgau S. Longterm quality of life after oncologic surgery and microvascular free flap reconstruction in patients with oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal 2016; 21:e420-4. [PMID: 27031070 PMCID: PMC4920454 DOI: 10.4317/medoral.21111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/21/2015] [Accepted: 01/21/2016] [Indexed: 01/19/2023] Open
Abstract
Background Quality of life (QoL) has become increasingly important in cancer treatment. It refers to the patient’s perception of the effects of the disease and therapy, and their impact on daily functioning and general feeling of well being. Material and Methods n this prospective study, a total of 100 patients treated at our institution, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and the specific EORTC QLQ-H&N35 module. The questionnaires were distributed to the patients between 12 and 60 months postoperatively. Results Global QoL score was 58.3 and mean score for functioning scale was 76.7. Fatigue (28.7 ± 26.1), followed by financial problems (27.7 ± 33.5), insomnia (26.7 ± 34.5) and pain (26.3 ± 29.9) had highest symptom score on QLQ-C30. Fatigue (r=-0.488), insomnia (r=-0.416) and pain (r =-0.448) showed highest value for significantly negative correlation to global QoL. In the H&N35 module, restriction of mouth opening (43.3 ± 38.6), dry mouth (40.7 ± 36.9), sticky saliva (37.3 ± 37.1) and eating in public (33.8 ± 31.9) were the four worst symptoms. Swallowing problem (r=-0.438), eating in public (r=-0.420) and persistent severe speech (r=-0.398) ranked as the three worst symptoms with highest value for significantly negative correlation to global QoL. Conclusions Longterm QoL after oncologic surgery and microvascular free flap reconstruction in patients with oral cancer is satisfactory. Measuring QoL should be considered as part of the evaluation of cancer treatment. Key words:Longterm quality of life, oral cancer, oncologic surgery, microvascular free flap reconstruction.
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Affiliation(s)
- A Peisker
- Department of Cranio-Maxillofacial & Plastic Surgery, Jena University Hospital, 07747 Jena, Germany,
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Raschke GF, Meissner W, Peisker A, Djedovic G, Rieger U, Guentsch A, Porwit D, Dammeier MG, Schultze-Mosgau S. Cranio-maxillofacial reconstruction with microvascular radialis flaps-parameters and correlations of postoperative pain management. Clin Oral Investig 2016; 21:429-436. [PMID: 27037570 DOI: 10.1007/s00784-016-1809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Postoperative pain management is of highest interest for patients undergoing maxillofacial surgery including microvascular reconstructive surgery. Currently, there is a lack of information regarding process and outcome of postoperative pain management after microvascular reconstruction. MATERIALS AND METHODS In a prospective clinical study, 31 adults were evaluated on the first postoperative day following microvascular reconstruction with a radial forearm flap using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It enables a standardized assessment of patients' characteristics, pain parameters, outcome and pain therapy process parameters. RESULTS Pain management consisted predominately of premedication with midazolam, sufentanil and metamizol intraoperatively, piritramid in the intensive care unit and metamizol, tramadol and fentanyl patches on ward. Nineteen patients (61.3 %) showed inadequate pain management with pain levels ≥4. Among other significant relations, patients exhibiting an age below the median presented significant higher levels of pain under strain (p = .041) and maximum pain (p = .006) as well as rate of breathing (p = .009) and mood (p = .006) disturbance. Performance of pain counselling showed specific impact on pain under strain (p = .008), maximum pain (p = .004) and satisfaction with pain intensity (p = .001). Whether microvascular reconstruction was performed with primary or secondary intention or performance of a neck dissection did not show significant influence. CONCLUSIONS QUIPS helped us to adequately evaluate the procedure-specific quality of postoperative management following microvascular reconstruction with a radial forearm flap. It helped us to identify a surprisingly high amount of inadequate pain management. Postoperative pain levels seem to be primarily influenced by the performed reconstruction. CLINICAL RELEVANCE Establishment of a continuous and procedure-specific evaluation of postoperative pain levels should help to avoid inadequate pain management, which is widely prevalent according to the literature and our study. Preoperative pain counselling is essential and should be procedure specific to be its best.
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Affiliation(s)
- Gregor F Raschke
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
| | - Winfried Meissner
- Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Andre Peisker
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Gabriel Djedovic
- Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany
| | - Ulrich Rieger
- Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany
| | - Arndt Guentsch
- Marquette University School of Dentistry, Milwaukee, WI, USA
| | - Daria Porwit
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Marta Gomez Dammeier
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Stefan Schultze-Mosgau
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
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Peisker A, Raschke GF, Guentsch A, Luepke P, Roshanghias K, Schultze-Mosgau S. Evaluation of a post-treatment follow-up program in patients with oral squamous cell carcinoma. Clin Oral Investig 2016; 21:135-141. [DOI: 10.1007/s00784-016-1764-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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21
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Raschke G, Djedovic G, Peisker A, Wohlrath R, Rieger U, Guentsch A, Gomez-Dammeier M, Schultze-Mosgau S. The isolated orbital floor fracture from a transconjunctival or subciliary perspective-A standardized anthropometric evaluation. Med Oral Patol Oral Cir Bucal 2016; 21:e111-7. [PMID: 26595833 PMCID: PMC4765746 DOI: 10.4317/medoral.20818] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 09/09/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The influence of orbital fractures and their repair on the rate of deformities of the lower eyelid is an ongoing source of discussion in the literature. Most of the present studies include isolated blow-out as well as combined orbital fractures. MATERIAL AND METHODS We present a retrospective evaluation of a series of 100 patients after isolated blow-out fracture repair using reference anthropometric data on standardized photographs. Analysis included eye fissure width and height, lid sulcus height, upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion and entropion. It was clearly distinguished between operated and contralateral eyelid, whether a transconjunctival or a subciliary approach was performed and amount of fracture. Our main interests were changes of the aforementioned parameters with regards to eyelid deformities. RESULTS Surgery per se did not significantly influence eyelid deformities. However, the surgical approach selected significantly affected eye fissure index, lower iris coverage and rate of scleral show, indicating retraction of the lower eyelid. CONCLUSIONS The standardized measurements described here are accurate and objective to evaluate postoperative results. The subciliary approach included the highest risk of lower lid retraction as compared to transconjunctival approaches.
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Affiliation(s)
- Gregor Raschke
- Department of Cranio-Maxillofacial, Plastic Surgery, Friedrich Schiller University Jena, Universitätsklinikum Jena, D-07747 Jena ,Germany,
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Raschke GF, Rieger UM, Peisker A, Djedovic G, Gomez-Dammeier M, Guentsch A, Schaefer O, Schultze-Mosgau S. Morphologic outcome of bimaxillary surgery--an anthropometric appraisal. Med Oral Patol Oral Cir Bucal 2015; 20:e103-10. [PMID: 25475769 PMCID: PMC4320412 DOI: 10.4317/medoral.19978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 03/17/2014] [Accepted: 06/17/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To adequately perform orthognathic surgery procedures, it is from basic interest to understand the morphologic changes caused by orthognathic surgery. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate and understand such changes. STUDY DESIGN We present a pre- to postoperative evaluation of orthognathic surgery results based on anthropometric indices described by Farkas and cephalometric measurements. 30 Class III patients undergoing maxillary advancement by Le Fort I Osteotomy and mandibular setback by bilateral sagittal split osteotomy were evaluated. Preoperative as well as three and nine months postoperative lateral cephalograms as well as standardized frontal view and profile photographs were taken. On the photographs 21 anthropometric indices given by Farkas were evaluated. In cephalograms SNA and SNB angle as well as Wits appraisal were investigated. RESULTS The investigated anthropometric indices showed a significant increase of the vertical height of the upper lip without changing the relation of the upper vermilion to the cutaneous upper lip. The lower vermilion height increased relatively to the cutaneous lower lip without vertical changes in the lower lip. Due to maxillary advancement the upper face height increased meanwhile the lower face height decreased due to mandibular setback. SNA and SNB angle and Wits appraisal showed typical changes related to surgery. CONCLUSIONS The investigated photo-assisted anthropometric measurements presented reproducible results related to bimaxillary surgery.
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Affiliation(s)
- Gregor F Raschke
- Department of Oral & Maxillofacial/Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany,
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Eggers C, Müller J, Schultze-Mosgau S. VEGF transfer based on gene-modified fibroblasts using a hypoxia-induced vector to modulate neoangiogenesis in ischaemic regions of myocutaneous transplants. Int J Oral Maxillofac Surg 2014; 44:267-76. [PMID: 25441860 DOI: 10.1016/j.ijom.2014.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022]
Abstract
The effect of a hypoxia-inducible VEGF-expressing on wound healing in an ischaemic hind leg rat model was evaluated in this study. 180 Wistar rats were assigned randomly to three groups. After ligation of the femoral artery, group 1 received pRTP801-VEGF165, group 2 untransfected fibroblasts, group 3 saline; injection was into the subcutaneous tissue, proximal and distal to the artery ligation. Biopsy specimens were obtained on days 3, 5, 7, 14 after implementation. VEGF transgene expression, vessel architecture, the amount and total area of vessel formation were investigated. Results showed a significantly higher level of VEGF protein expression in group 1 compared to group 2 (P≤0.001) throughout the investigational period. Group 1 exhibited a significant growth of CD31-positive blood vessels in the subcutaneous tissue on day 14 compared to groups 2 and 3 (P≤0.001) (group 1, 62.20±1.92; group 2, 20.60±1.67; group 3, 12.40±1.14). Alpha-SMA-positive staining also showed significant vessel growth in group 1 on day 5 (group 1, 27.00±1.87; group 2, 7.20±1.48; group 3, 10.00±1.73). These results were confirmed in the distal muscle tissue. No significant results were obtained for the proximal muscle tissue. The subcutaneous application of pRTP801-VEGF165 showed a long-lasting effect, with an increased expression of VEGF over the entire observation period. It appears that the use of fibroblasts transfected with VEGF is a promising way to increase early angiogenesis in ischaemic tissue.
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Affiliation(s)
- C Eggers
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany.
| | - J Müller
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany
| | - S Schultze-Mosgau
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany
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24
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Guntinas-Lichius O, Wendt TG, Kornetzky N, Buentzel J, Esser D, Böger D, Müller A, Schultze-Mosgau S, Schlattmann P, Schmalenberg H. Trends in epidemiology and treatment and outcome for head and neck cancer: A population-based long-term analysis from 1996 to 2011 of the Thuringian cancer registry. Oral Oncol 2014; 50:1157-64. [DOI: 10.1016/j.oraloncology.2014.09.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/18/2014] [Accepted: 09/28/2014] [Indexed: 12/24/2022]
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Peisker A, Raschke GF, Guentsch A, Roshanghias K, Schultze-Mosgau S. Management of dental extraction in a female patient with fanconi anemia. J Dent (Tehran) 2014; 11:613-9. [PMID: 25628690 PMCID: PMC4290783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/17/2014] [Indexed: 11/06/2022]
Abstract
Oral surgery in patients with bleeding disorders is associated with a high risk of bleeding during and after surgery. This article is aimed to present the case of an eight-year-old girl suffering from severe Fanconi anemia with pancytopenia who underwent a dental extraction. The hemostatic effect of local administration of tranexamic acid in combination with a primary suture seems to be extremely helpful in order to reduce the necessity of blood products and the risk of postoperative bleeding.
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Affiliation(s)
- Andre Peisker
- Department of Cranio-Maxillofacial & Plastic Surgery, Jena University Hospital, Jena, Germany,Corresponding author: A. Peisker, Department of Cranio-Maxillofacial & Plastic Surgery, Jena University Hospital, Jena, Germany,
| | | | - Arndt Guentsch
- Center of Dental Medicine, Jena University Hospital, Jena, Germany, Department of Surgical Sciences, Marquette University, School of Dentistry, Milwaukee, Wisconsin, USA
| | | | - Stefan Schultze-Mosgau
- Professor, Department of Cranio-Maxillofacial & Plastic Surgery, JenaUniversity Hospital, Jena, Germany
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Raschke GF, Rieger UM, Bader RD, Schaefer O, Guentsch A, Gomez Dammeier M, Schultze-Mosgau S. Perioral aging – An anthropometric appraisal. J Craniomaxillofac Surg 2014; 42:e312-7. [DOI: 10.1016/j.jcms.2013.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/28/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022] Open
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Peisker A, Kentouche K, Raschke GF, Schultze-Mosgau S. Management of third molar removal with doses of native plasma-derived factor IX (Octanine) and local measures in a female patient with severe hemophilia B: a case report. Quintessence Int 2014; 45:239-43. [PMID: 24570991 DOI: 10.3290/j.qi.a31204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with hemophilia are at high risk of bleeding following oral surgery. As an X-linked recessive chromosomal bleeding disorder it is very rare in female patients. This is the first described case of management of third molar removal in a female patient suffering from severe hemophilia B. Excellent hemostasis was achieved by following a protocol using defined pre- and postoperative doses of factor IX and local hemostatic measures of collagen fleece, fibrin glue, primary suture, and tranexamic acid solution. Following defined protocols is essential in the management of oral surgery in patients with hemophilia and helps to prevent postoperative hemorrhages.
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Schultze-Mosgau S, Grabenbauer GG, Wehrhan F, Radespiel-Tröger M, Wiltfang J, Sauer R, Rödel F. Histomorphologische Strukturveränderungen von Kopf-Hals-Gefäßen nach prä- oder postoperativer Radiotherapie. Strahlenther Onkol 2014. [DOI: 10.1007/s00066-002-0953-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bekhite MM, Finkensieper A, Rebhan J, Huse S, Schultze-Mosgau S, Figulla HR, Sauer H, Wartenberg M. Hypoxia, Leptin, and Vascular Endothelial Growth Factor Stimulate Vascular Endothelial Cell Differentiation of Human Adipose Tissue-Derived Stem Cells. Stem Cells Dev 2014; 23:333-51. [DOI: 10.1089/scd.2013.0268] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Mohamed M. Bekhite
- Clinic of Internal Medicine I, Department of Cardiology, University Heart Center, Jena University Hospital, Jena, Germany
- Department of Zoology, Faculty of Science, Tanta University, Tanta, Egypt
| | - Andreas Finkensieper
- Clinic of Internal Medicine I, Department of Cardiology, University Heart Center, Jena University Hospital, Jena, Germany
| | - Jennifer Rebhan
- Clinic of Internal Medicine I, Department of Cardiology, University Heart Center, Jena University Hospital, Jena, Germany
| | - Stephanie Huse
- Clinic of Internal Medicine I, Department of Cardiology, University Heart Center, Jena University Hospital, Jena, Germany
| | - Stefan Schultze-Mosgau
- Department of Cranio-Maxillofacial Surgery and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Hans-Reiner Figulla
- Clinic of Internal Medicine I, Department of Cardiology, University Heart Center, Jena University Hospital, Jena, Germany
| | - Heinrich Sauer
- Department of Physiology, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Maria Wartenberg
- Clinic of Internal Medicine I, Department of Cardiology, University Heart Center, Jena University Hospital, Jena, Germany
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Abstract
Since the last 30 years endosseous implants are a well established treatment technique in maxillofacial surgery. Implants are used in the rehabilitation of patients having lost parts of maxilla or mandible due to tumor surgery, or which due to radiotherapy have problems tolerating mucosa-borne dentures. The implant borne prosthesis will aid to regain live quality to those patients. Improvement of live quality is also the result when epithetic reconstructions of soft tissue defects in the face are stabilized by extraoral implants. Aim of the paper is to give an overview on important implant related pathophysiological osseous healing patterns, discuss methods to influence these processes, to show correction possibilities for the bony bed and highlight their indications as well as to inform about clinical experiences with endosseous implants.
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Affiliation(s)
- K A Schlegel
- Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg Glückstrasse 11, 91054 Erlangen.
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Peisker A, Raschke GF, Schultze-Mosgau S. Management of dental extraction in patients with Haemophilia A and B: a report of 58 extractions. Med Oral Patol Oral Cir Bucal 2014; 19:e55-60. [PMID: 24121912 PMCID: PMC3909433 DOI: 10.4317/medoral.19191] [Citation(s) in RCA: 15] [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: 03/12/2013] [Accepted: 08/12/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Patients with inherited bleeding disorders are at high risk of bleeding following oral surgery and present challenges to the oral surgeons. Aim of this study was to report our experience in dental extraction in patients exhibiting Haemophilia A and B between 2007 and 2012. PATIENT AND METHODS 58 dental extractions in 15 patients during 19 interventions were performed. Replacement therapy with recombinant and plasma-derived factor VIII and IX was applied systematically in combination with antifibrinolytic treatment and local haemostatic measures. The following data were recorded: type of surgery, applied local haemostatic measures, general substitution, systemic antifibrinolytic agents and occurrence of postoperative bleeding complications. RESULTS Two patients presented postoperative bleeding. One had secondary bleeding requiring additional injection of factor concentrates. The other one presented epistaxis which was managed conservatively with a nasal tamponade. CONCLUSIONS Excellent haemostasis is achievable after dental extractions in patients with Haemophilia A and B by following a protocol using defined pre- and postoperative doses of factor concentrates in combination with haemostatic measures.
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Affiliation(s)
- Andre Peisker
- Department of Cranio-Maxillofacial, Plastic Surgery, Friedrich Schiller University Jena, Universitätsklinikum Jena, D-07747 Jena, Germany,
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Oemus D, Inhestern J, Schmalenberg H, Schultze-Mosgau S, Mentzel HJ, Guntinas-Lichius O. Prognostic value of tumor volumetry data of routine imaging data in a head and neck cancer registry. Eur Arch Otorhinolaryngol 2013; 271:2531-7. [DOI: 10.1007/s00405-013-2800-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/28/2013] [Indexed: 12/24/2022]
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33
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Schultze-Mosgau S. Concepts of flapless surgery for implantation. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.326] [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: 11/16/2022]
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34
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Schultze-Mosgau S. Minimally invasive implant insertion based on computer supported implant planning. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.325] [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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35
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Lai Y, Chen J, Zhang T, Gu D, Zhang C, Li Z, Lin S, Fu X, Schultze-Mosgau S. Effect of 3D microgroove surface topography on plasma and cellular fibronectin of human gingival fibroblasts. J Dent 2013; 41:1109-21. [PMID: 23948393 DOI: 10.1016/j.jdent.2013.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/02/2013] [Accepted: 08/03/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Fibronectin (FN), an extracellular matrix (ECM) glycoprotein, is a key factor in the compatibility of dental implant materials. Our objective was to determine the optimal dimensions of microgrooves in the transmucosal part of a dental implant, for optimal absorption of plasma FN and expression of cellular FN by human gingival fibroblasts (HGFs). METHODS Microgroove titanium surfaces were fabricated by photolithography with parallel grooves: 15μm, 30μm, or 60μm in width and 5μm or 10μm in depth. Smooth titanium surfaces were used as controls. Surface hydrophilicity, plasma FN adsorption and cellular FN expression by HGFs were measured for both microgroove and control samples. RESULTS We found that narrower and deeper microgrooves amplified surface hydrophobicity. A 15-μm wide microgroove was the most hydrophobic surface and a 60-μm wide microgroove was the most hydrophilic. The latter had more expression of cellular FN than any other surface, but less absorption of plasma FN than 15-μm wide microgrooves. Variation in microgroove depth did not appear to effect FN absorption or expression unless the groove was narrow (∼15 or 30μm). In those instances, the shallower depths resulted in greater expression of cellular FN. CONCLUSIONS Our microgrooves improved expression of cellular FN, which functionally compensated for plasma FN. A microgroove width of 60μm and depth of 5 or 10μm appears to be optimal for the transmucosal part of the dental implant.
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Affiliation(s)
- Yingzhen Lai
- School of Stomatology, Fujian Medical University, Fuzhou, Fujian 350000, China
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36
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Raschke GF, Rieger UM, Bader RD, Guentsch A, Schaefer O, Elstner S, Schultze-Mosgau S. Cheek rotation flap reconstruction—an anthropometric appraisal of surgical outcomes. Clin Oral Investig 2013; 18:1251-1257. [DOI: 10.1007/s00784-013-1075-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 07/24/2013] [Indexed: 11/30/2022]
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37
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Mueller CK, Solcher P, Peisker A, Mtsariashvilli M, Schlegel KA, Hildebrand G, Rost J, Liefeith K, Chen J, Schultze-Mosgau S. Analysis of the influence of the macro- and microstructure of dental zirconium implants on osseointegration: a minipig study. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e1-8. [DOI: 10.1016/j.oooo.2011.10.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/14/2011] [Accepted: 10/24/2011] [Indexed: 10/28/2022]
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38
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Raschke GF, Rieger UM, Bader RD, Schaefer O, Guentsch A, Hagemeister C, Schultze-Mosgau S. The zygomaticomaxillary complex fracture – An anthropometric appraisal of surgical outcomes. J Craniomaxillofac Surg 2013; 41:331-7. [DOI: 10.1016/j.jcms.2012.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 10/16/2012] [Accepted: 10/18/2012] [Indexed: 11/27/2022] Open
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Mueller CK, Thorwarth M, Chen J, Schultze-Mosgau S. A laboratory study comparing the effect of ridge exposure using tissue punch versus mucoperiosteal flap on the formation of the implant-epithelial junction. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:S41-5. [DOI: 10.1016/j.tripleo.2011.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 06/30/2011] [Accepted: 08/03/2011] [Indexed: 12/14/2022]
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Moeller K, Esser D, Boeger D, Buentzel J, Hoffmann K, Jecker P, Mueller A, Radtke G, Piesold JU, Schultze-Mosgau S, Finkensieper M, Bitter T, Guntinas-Lichius O. Parotidectomy and submandibulectomy for benign diseases in Thuringia, Germany: a population-based study on epidemiology and outcome. Eur Arch Otorhinolaryngol 2012; 270:1149-55. [PMID: 23073736 DOI: 10.1007/s00405-012-2225-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 10/07/2012] [Indexed: 01/13/2023]
Abstract
Although salivary gland surgery for benign diseases is an integral part of clinical routine of head and neck surgeons, there is not many population-based data published on incidence and efficiency of this surgery. Parotidectomy was performed in 180 patients and submandibulectomy in 97 patients for benign diseases in eight otorhinolaryngology and two maxillofacial surgery departments in Thuringia, Germany, in 2005. All patients were analysed regarding patients' characteristics, therapy, complications and further course of disease. Predominant indications were epithelial tumours for parotidectomy (79 %) and sialolithiasis for submandibulectomy (50 %). The most frequent tumour types were pleomorphic adenoma (46 %) and Warthin tumours (29 %). Pleomorphic adenoma was significantly more frequent in female patients and Warthin tumours in male patients and smokers. The incidence of parotidectomy, i.e. the surgical rate, was 7.8/100,000 habitants and of submandibulectomy 4.1/100,000 habitants. One hundred and seventy-eight tumours including 154 epithelial tumours resulted in an incidence of 7.6/100,000 habitants for all treated tumours and of 6.6/100,000 for epithelial tumours, respectively. The majority of parotid cases were treated by lateral parotidectomy (79 %). Relevant complications were observed in 22 % of patients. After parotidectomy and submandibulectomy a postoperative facial palsy was observed in 28 and 2 % of cases, respectively. Only 1 % was permanent. During a mean follow-up time of 9.6 months, 3 % of parotidectomy patients developed a Frey's syndrome needing treatment and 0.8 % developed a tumour recurrence. This population-based analysis shows that salivary gland surgery is performed in higher incidence than expected, effectively and with low-risk in daily routine of head and neck surgeons.
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Affiliation(s)
- K Moeller
- Department of Otorhinolaryngology, Helios-Klinikum, Erfurt, Germany
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Raschke GF, Rieger UM, Bader RD, Guentsch A, Schaefer O, Schultze-Mosgau S. Soft tissue outcome after mandibular advancement--an anthropometric evaluation of 171 consecutive patients. Clin Oral Investig 2012; 17:1415-23. [PMID: 22893037 DOI: 10.1007/s00784-012-0821-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 08/01/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There is an ongoing discussion in the literature about preoperative planning and postoperative evaluation of orthognathic surgery and its impact on facial appearance and aesthetics. MATERIALS AND METHODS We present an anthropometric and cephalometric evaluation of orthognathic surgery results based on reference anthropometric data. In 171 Class II patients, mandibular advancement by bilateral sagittal split osteotomy was performed. Preoperative as well as 3 and 9 months postoperative standardized frontal view and profile photographs and lateral cephalograms were evaluated in a standardized manner by use of 21 anthropometric indices. In cephalograms, SNA and SNB angle as well as Wits appraisal were investigated. Results of anthropometric and cephalometric measurements were correlated. RESULTS Lower vermilion contour, vermilion and cutaneous total lower lip height, nose-lower face height, nose-face height, upper face-face height, upper lip- and chin-mandible height index showed significant pre- to postoperative changes as well as SNB angle and Wits appraisal. Furthermore, medial-lateral cutaneous upper lip height, vermilion and cutaneous total lower lip height and philtrum-mouth width index presented significant correlations to cephalometric measurements. CONCLUSIONS The investigated anthropometric indices and cephalometric measurements presented reproducible results related to surgery. The correlation of cephalometric to anthropometric measurements has been proven useful for preoperative planning and postoperative evaluation of orthognathic surgery patients. CLINICAL RELEVANCE The presented anthropometric measurements and their observed correlation to cephalometric measurements could lead to a better prediction and optimized planning of the soft tissue result in orthognathic surgery patients and thereby improve the aesthetic outcome.
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Affiliation(s)
- Gregor F Raschke
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, Jena, Germany
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42
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Raschke GF, Rieger UM, Bader RD, Schaefer O, Guentsch A, Schultze-Mosgau S. Transconjunctival versus subciliary approach for orbital fracture repair—an anthropometric evaluation of 221 cases. Clin Oral Investig 2012; 17:933-42. [DOI: 10.1007/s00784-012-0776-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
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43
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Rauchfuss F, Bader RD, Dittmar Y, Schultze-Mosgau S, Settmacher U, Scheuerlein H. [The latissimus dorsi myocutaneous free flap--a salvage option for abdominal wall reconstruction in complex incisional hernias]. HANDCHIR MIKROCHIR P 2012; 44:93-6. [PMID: 22495961 DOI: 10.1055/s-0031-1299743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Complex incisional hernias are a serious burden for the patient and a challenge for the surgeon. The main problem is the covering of the defect after the resection of large proportions of low-grade tissue. In this work, we describe 2 patients who underwent complex reconstruction of recurrent incisional hernias using a bovine pericardium mesh (Tutomesh®) and a latissimus dorsi myocutaneous free flap.
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Affiliation(s)
- F Rauchfuss
- University Hospital Jena, Department of General, Visceral and Vascular Surgery, Jena
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Fu X, Chen J, Wu D, Du Z, Lei Q, Cai Z, Schultze-Mosgau S. Effects of ovariectomy on rat mandibular cortical bone: a study using Raman spectroscopy and multivariate analysis. Anal Chem 2012; 84:3318-23. [PMID: 22401368 DOI: 10.1021/ac300046x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To investigate the effects of ovariectomy (OVX) on rat mandibular bone, the physicochemical compositions of mandibular cortical bone of ovariectomy and sham operated rats 2, 4, and 8 months after surgery were compared using Raman spectroscopy. With principal component analysis and linear discriminant analysis based on the Raman spectra, the mandibular cortical bone of the OVX group was clearly distinguished from that of the sham-operated group 8 months after surgery with no overlap. Specifically, significant reductions in the mineral-to-matrix ratio and full width at half-maximum as well as a significant increase in the carbonate-to-phosphate ratio were observed in the mandibular cortical bone of the OVX group. Results support the hypothesis that Raman spectroscopy is sensitive enough to distinguish between OVX and sham-operated mandibles with multivariate analysis by detecting the chemical composition of the mandibular cortical bone. The parameters mineral-to-matrix ratio, carbonate-to-phosphate ratio, and full width at half-maximum can appropriately characterize changes in the chemical composition of the mandibular cortical bone after OVX.
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Affiliation(s)
- Xiaoming Fu
- School of Stomatology, Fujian Medical University, Fuzhou, Fujian 350000, China
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Raschke GF, Rieger UM, Bader RD, Kirschbaum M, Eckardt N, Schultze-Mosgau S. Evaluation of nasal reconstruction procedures results. J Craniomaxillofac Surg 2012; 40:743-9. [PMID: 22421468 DOI: 10.1016/j.jcms.2012.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 11/30/2022] Open
Abstract
Before undergoing a reconstructive procedures of the nose most patients ask how they will look postoperatively. Anthropometric measurements of the nose described by Farkas represent standard values. A comparison of pre- and postoperative anthropometric measurements may help to double-check the correctness of intraoperative "eye-balling" measurements with regards to postoperative appearance. Sixty-three patients underwent reconstruction of nasal ala, tip or dorsum. An analysis of standardized pre- and postoperative photographs included measurements of nose width, nose height, nasal tip protrusion, columella width, ala length, intercanthal width, mouth width, philtrum width, upper lip height, lateral upper lip height, cutaneous upper lip height and upper face height. Preoperative measurements were compared to data given by Farkas in young adults. Postoperative changes were evaluated clearly distinguishing between reconstruction of nasal ala, tip and dorsum. All anthropometric indices showed significant differences compared to the Farkas population. There was no significant pre- to postoperative change in any reconstructed region observed, indicating adequate intraoperative measurements. The application of Farkas' anthropometric measurements described in this study showed reliable and objective results and can help to double-check the previous intraoperative measurements. The correct application of these surgical techniques leads to a satisfying and near to normal postoperative look of the patient.
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Affiliation(s)
- Gregor F Raschke
- Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University Jena, Universitätsklinikum Jena, Erlanger Allee 101, D-07747 Jena, Germany.
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Raschke GF, Rieger UM, Bader RD, Schultze-Mosgau S. Lip reconstruction: an anthropometric and functional analysis of surgical outcomes. Int J Oral Maxillofac Surg 2012; 41:744-50. [PMID: 22410272 DOI: 10.1016/j.ijom.2012.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 11/02/2011] [Accepted: 02/02/2012] [Indexed: 12/01/2022]
Abstract
Postoperative evaluation of results of reconstructive procedures of the lips mainly consists of describing the technique, complications and subjectively interpreted patient photographs. The authors present a photo-assisted pre- to postoperative evaluation of reconstructive procedures of the lips based on anthropometric measurements and functional outcome. Forty-eight patients underwent partial or full thickness excision of tumours of the lips and subsequent reconstruction. An analysis of standardized pre- and postoperative photographs included measurements of intercanthal width, mouth width, philtrum width, lateral upper lip height, upper and lower lip height, cutaneous upper and lower lip height, upper and lower vermilion arc and upper and lower vermilion height. Assessment of functional outcome consisted of the evaluation of oral competence, changes of oral opening and sensation. The effects on the described parameters were analysed, when partial or full thickness reconstruction had to be performed. Intercanthal mouth width index, vermilion arc index, vermilion and cutaneous total lower lip height index showed statistically significant effects postoperatively which indicates a postoperative tightened lower lip, when full-thickness excision was performed. In all patients the indices were proven reproducible and reliable. The standardized measurements described are accurate and objective for evaluating postoperative results.
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Affiliation(s)
- G F Raschke
- Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany.
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Mueller CK, Thorwarth M, Schmidt M, Schlegel KA, Schultze-Mosgau S. Comparative analysis of osseointegration of titanium implants with acid-etched surfaces and different biomolecular coatings. ACTA ACUST UNITED AC 2011; 112:726-36. [DOI: 10.1016/j.tripleo.2011.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 12/07/2010] [Accepted: 01/01/2011] [Indexed: 10/18/2022]
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Mueller CK, Thorwarth M, Schultze-Mosgau S. Histomorphometric and whole-genome expression analysis of peri-implant soft tissue healing: a comparison of flapless and open surgery. Int J Oral Maxillofac Implants 2011; 26:760-767. [PMID: 21841985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
PURPOSE The structure of peri-implant soft tissue that is regenerated after flapless and flap surgery has been shown to differ. However, its underlying mechanisms are relatively unknown. The present study sought to identify differences in the inflammatory cell infiltration and expression of gene transcripts during transmucosal healing between the two approaches with two different implant designs. MATERIALS AND METHODS All mandibular premolars were removed from 12 minipigs. One month later, four implants (two NobelReplace Tapered Groovy and two NobelPerfect Groovy, Nobel Biocare) were placed in each quadrant. One quadrant was randomized to flapless insertion, while the other was chosen for flap surgery in each animal. Following 1, 2, 4, and 12 weeks of transmucosal implant healing, biopsy specimens were retrieved from the peri-implant soft tissue according to a standardized procedure to avoid crossover effects. Samples were subjected to a leukocyte count and a gene expression analysis. RESULTS When the flapless placement technique was used, leukocyte influx in the peri-implant soft tissue was significantly smaller compared to open surgery for both implant designs. Gene expression analysis revealed significant overexpression of molecules associated with detoxification and reepithelialization in the flapless group. In contrast, myofibroblast-associated gene transcripts were significantly enriched in the flap surgery group. CONCLUSIONS The present data indicate perpetuation of inflammatory reactions as well as increased fibrotic scar tissue deposition in the peri-implant area following implant placement by the flap approach. Flapless implant insertion results in less inflammation and early reepithelialization, providing the potential for the formation of a fully functioning as well as esthetically preferable peri-implant soft tissue collar.
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Affiliation(s)
- Cornelia Katharina Mueller
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, School of Medicine, University of Jena, Germany.
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Mueller CK, Bader RD, Schultze-Mosgau S. Microvascular Free Flaps for Mandibular Reconstruction in Goldenhar Syndrome. J Craniofac Surg 2011; 22:1161-3. [DOI: 10.1097/scs.0b013e318210bbec] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mueller C, Schultze-Mosgau S. Histomorphometric analysis of the phenotypical differentiation of recruited macrophages following subcutaneous implantation of an allogenous acellular dermal matrix. Int J Oral Maxillofac Surg 2011; 40:401-7. [DOI: 10.1016/j.ijom.2010.10.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 08/16/2010] [Accepted: 10/27/2010] [Indexed: 12/12/2022]
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