SURGICALLY ASSISTED RAPID MAXILLARY EXPANSION: RETROSPECTIVE ANALYSIS OF COMPLICATIONS 2012-2017

Surgically assisted rapid maxillary expansion (SARME) is a common technique developed to treat skeletally mature patients with transverse maxillary deficiency. Although SARME is supposed to be a relatively safe procedure, it is not completely free of complications. The purpose of this study was to reveal the most typical postoperative SARME complications. Retrospective evaluation of the clinical cases of 665 patients (247 males and 418 females, mean age 25,3 years) with the diagnosis of maxillary transverse deficiency, who underwent SARME in period between 2012 and 2017 at the Clinical Center of Maxillofacial, Plastic Surgery and Dentistry, Moscow. According to the results of the research, the most typical complications of SARME are paresthesia of the infraorbital nerve branches and nasopalatine nerve (198/665), distraction device dislocation (61/665), inflammation in the distraction device area (57/665), insufficient expansion of the maxilla (42/665), asymmetric expansion (27/665). The number of complications revealed indicates that SARME is an operation associated with the risks of postoperative complications. Careful treatment planning, following the operation protocol and performing the minimally invasive access can help to avoid the majority of complications.

Psychiatric Disorders in Patients With Atypical Facial Pain

Objective

Maxillofacial surgeons and dentists often (up to 10%) deal with the phenomenon of atypical facial pain (AFP) – painful condition of maxillofacial area without clear organic pathology. Psychiatric studies of this disorder are almost lacking.

Aim

The aim of this study was to define psychopathological disorders in patients with AFP and to set up psychopharmacological treatment strategies.

Methods

The study used clinical psychopathological and psychometric (Pain measurement scales: Brief Pain Inventory, VAS, Pain Catastrophizing Scale) methods. We included patients with AFP examined in the clinic in December 2014 - September 2015.

Results

Study sample consists of 54 patients with AFP: 45 women (83.3%), 9 men (16.7%), 18-70 years old (39.5 ± 14.7 years). In 67.8% of patients (33 women, 4 men), AFP was associated with affective disorders; among them, recurrent major depressive disorder was verified in 9.2% (4 women, 1 men), single depressive episode – in 33.6% (15 women, 3 man), bipolar II depression – in 3.6% (2 women), cyclothymic disorder – in 7.1% (4 women), dysthymia – in 14.3% (8 women). In 10.8% of patients (6 women), AFP was considered as a symptom of somatoform pain disorder. In 21.4% (6 women, 5 men), AFP was related with schizotypal personality disorder. Psychopharmacological agents used were SSRIs (fluvoxamine, escitalopram), SNRIs (venlafaxine, duloxetine), agomelatine and antipsychotics (quetiapine, amisulpride, alimemazine). The pain subsides in 87,04% of patients and the severity of pain decreased in 12.96% of patients.

Conclusion

Patients with AFP should be examined by psychiatrist in order to determine psychopathological disorders and to elaborate psychopharmacological treatment strategies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Proportions of anxiety and depression symptoms in adult cleft patients and non-cleft patients with skeletal malocclusions

Introduction

Diagnosis and treatment of patients with craniofacial anomalies such as cleft lip and palate and skeletal malocclusions present a challenge to public health. Dentofacial abnormalities may be associated with depressive and anxiety disorders and poor quality of life.

The aim of this screening study was to evaluate and to compare the rates of anxiety and depression in cleft patients and non-cleft patients with skeletal malocclusions.

Methods

The study used psychometric method-HADS and State Trait Anxiety Inventory were used. The first group consisted of cleft patients, the second group consisted of non-cleft patients with skeletal Class II, Class III and anterior open bite malocclusions; the third group was control.

Results

Study sample consists of 42 patients (33 females; 24 ± 7.2 years). In the 1st group, anxiety symptoms were detected in 34.7%; depression symptoms - in 17.2% of patients, high rates of reactive anxiety were registered in 35.8%. In the 2nd group, anxiety symptoms were detected in 29.6% of patients; depression symptoms - in 13,1% of patients, high rates of reactive anxiety were registered in 34.2%. In the 3rd group anxiety (18.7%) and depression (8.3%) symptoms and high rates of reactive anxiety (17.7%) were registered significantly less often than in 1st and 2nd groups (P < 0.005, P < 0.001 and P < 0.001 respectively).

Conclusions

Our data suggest that cleft-patients and non-cleft patients with skeletal malocclusions have statistically significant higher rates of anxiety and depression than controls and require orthodontic-surgical treatment that should be organized with the assistance of psychiatrist.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Sequence analysis by hybridization with oligonucleotide microchip: identification of beta-thalassemia mutations

Diagnostics for genetic diseases were run and sequence analysis of DNA was carried out by hybridization of RNA transcripts with oligonucleotide array microchips. Polyacrylamide gel pads (100 x 100 x 20 microm) were fixed on a glass slide of the microchip and contained allele-specific immobilized oligonucleotides (10-mers). The RNA transcripts of PCR-amplified genomic DNA were fluorescently labeled by enzymatic or chemical methods and hybridized with the microchips. The simultaneous measurement in real time of the hybridization and melting on the entire oligonucleotide array was carried out with a fluorescence microscope equipped with CCD camera. The monitoring of the hybridization specificity for duplexes with different stabilities and AT content was enhanced by its measurement at optimal, discrimination temperatures on melting curves. Microchip diagnostics were optimized by choosing the proper allele-specific oligonucleotides from among the set of overlapping oligomers. The accuracy of mutation detection can be increased by simultaneous hybridization of the microchip with two differently labeled samples and by parallel monitoring their hybridization with a multi-wavelength fluorescence microscope. The efficiency and reliability of the sequence analysis were demonstrated with diagnostics for beta-thalassemia mutations.

Clinical indications for the use of the "Poisk-IOM" total artificial heart: the experience of 13 implantations in humans

Success of total artificial heart (TAH) implantation as a temporary measure depends on three factors: proper patient selection, adequate surgical technique, and safe cardiac prostheses. From 1986 until March 1990, 237 patients with stagnant heart failure were examined. Sixty-one patients (27%) were put on a waiting list. Thirty-eight percent of them died awaiting transplantation. Thirteen TAH implantations were performed; nine patients who were not on a waiting list underwent TAH implantation by urgent indications. Four other patients underwent bridge TAH implantation after cardiac surgery. Our experience shows that the status of a patient before transplantation is a determinant factor and that it is possible to perform TAH implantation only in patients on a waiting list.