1
|
Nickenig HJ, Terheyden H, Reich RH, Kreppel M, Linz C, Lentzen MP. Oral health-related quality of life (OHRQoL) and implant therapy: A prospective multicenter study of preoperative, intermediate, and posttreatment assessment. J Craniomaxillofac Surg 2024; 52:59-64. [PMID: 37891090 DOI: 10.1016/j.jcms.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 10/29/2023] Open
Abstract
The purpose of this multicenter continuation study was to use high patient numbers in order to generate reliable statements regarding the association between different implant indications and OHRQoL. Patients with various types of indication for dental implants, ranging from single tooth loss to edentulous jaws, were included. Quality of life relating to dental implants was assessed through the oral health impact profile (OHIP-G-21), which has a summary score from 0 to 20 in healthy patients. In total, 16 253 patients from 29 centers (European Centers for Dental Implantology (ECDI)) were involved in the study between 2009 and 2021.8251 patients (50.7%) completed the questionnaire after implant insertion, and 4996 patients (30.7%) after prosthodontic treatment. The average age was 54 years (range 18-88 years). Posterior single-tooth gap (28.5%) and free-end gap (27.8%) were the most frequent indications. The preoperative OHIP-G-21 score for all patients was 32.81 (SD 11.92), while the score during the healing period was 30.00 (SD 10.72), and after completion of treatment 27.24 (SD 9.26) (p < 0.001). The most significant improvements in OHIP-G-21 scores were in the indication of edentulous jaw (phase 1, 41.81 (SD 15.53); phase 2, 35.39 (SD 14.22); phase 3, 29.60 (SD 10.12) (p < 0.001). The study revealed significant improvements in the most frequently reported problems (chewing, serious concerns, appearance) (p < 0.001). Insertion of dental implants and prosthodontic rehabilitation led to an improved OHRQoL for patients with all indications for dental implants. Special attention should be paid to patients with edentulous jaw, since in comparison with other indications it had the greatest impact on improving OHRQoL. The psychological dissatisfaction scale of the OHIP-G-21 represented the most important factors for patients, and these scores were substantially influenced by implant therapy. Thus, treating physicians should increase their focus on these factors, in order to avoid dissatisfaction and increase the likelihood of complete implant therapy success.
Collapse
Affiliation(s)
- Hans-Joachim Nickenig
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Hendrik Terheyden
- Department for Oral and Maxillofacial Surgery, Red Cross Hospital Kassel, Germany
| | - Rudolf H Reich
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Bonn and Faculty of Medicine, University of Bonn, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Christian Linz
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Max-Philipp Lentzen
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany.
| |
Collapse
|
2
|
Büttner R, Gültekin SE, Heydt C, Nogova L, Meemboor S, Kreppel M, Aziz-Heiloun R. Efficiency of B-RAF-/MEK-inhibitors in B-RAF mutated Ameloblastoma: Case report and review of literature. Heliyon 2023; 9:e23206. [PMID: 38149213 PMCID: PMC10750065 DOI: 10.1016/j.heliyon.2023.e23206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023] Open
Abstract
Background Ameloblastoma is a benign but locally invasive and aggressive odontogenic tumor harboring activating BRAF V600E mutations in about two thirds of the cases. Case presentation Neoadjuvant therapy with Dabrafenib and Trametinib was given to a 42-year-old male patient with recurrent ameloblastoma of the right mandible with a BRAF V600E mutation for 18 months. The patient manifested an excellent response to the therapy with remarkable reduction in tumor size from 72.6 mm to 55.9 mm. Histopathologically, the tumor underwent significant degenerative changes with only a few sparse vital residuals revealing 0 % Ki67 proliferative index. Conclusions Neoadjuvant therapy with BRAF-inhibitors or BRAF-MEK-inhibitors is an effective means to reduce the size of mandibulary ameloblastomas. We propose the consideration of neoadjuvant therapy in future treatment modalities to minimize post-surgical morbidity and facial deformations.
Collapse
Affiliation(s)
- Reinhard Büttner
- Institute of Pathology, Medical Faculty, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Sibel Elif Gültekin
- Faculty of Dentistry, Department of Oral Pathology, Gazi University, Emek, 06510, Ankara, Turkey
| | - Carina Heydt
- Institute of Pathology, Medical Faculty, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Lucia Nogova
- Clinic of Internal Medicine I, Medical Faculty, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Sonja Meemboor
- Institute of Pathology, Medical Faculty, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matthias Kreppel
- Clinic of Maxillofacial Surgery, Medical Faculty, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Reem Aziz-Heiloun
- Institute of Pathology, Medical Faculty, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| |
Collapse
|
3
|
Nickenig HJ, Zöller JE, Kreppel M. Indications and surgical technique for distraction osteogenesis of the alveolar bone for augmentation prior to insertion of dental implants. Periodontol 2000 2023; 93:327-339. [PMID: 37940190 DOI: 10.1111/prd.12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 11/10/2023]
Abstract
When bone is limited, short, ultra-short, or narrow implants help to restore oral rehabilitation with an acceptable long-term outcome. This becomes more difficult with severe vertical bone loss. Guided bone regeneration, onlay block transplantation, or sandwich osteotomy have been established to build up these defects. The alternative to the alveolar distraction osteogenesis (ADO) has only been established in some centers, with a standardized protocol. On the one hand, ADO is a biological procedure that allows almost a "restitutio ad integrum" when building up hard and soft tissue. On the other hand, there are clear indications, limitations, and complications of the procedure in the literature. In addition to the literature, concept of Tissue Regeneration by Alveolar Callusdistraction Cologne (TRACC), which has been practiced successfully for over two decades, will be presented for different indications.
Collapse
Affiliation(s)
- Hans-Joachim Nickenig
- Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
- Interdisciplinary Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
- Interdisciplinary Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
- Interdisciplinary Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| |
Collapse
|
4
|
Riekert M, Lentzen MP, Tiddens J, Zöller JE, Kreppel M, Schick V. Prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures - A retrospective cohort study. J Craniomaxillofac Surg 2023; 51:454-459. [PMID: 37453892 DOI: 10.1016/j.jcms.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/11/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
The aim of the study was to evaluate prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures. Complaints after fracture treatment and complications after plate removal were analyzed, retrospectively. A total of 205 patients were included. Plate removal was performed in 99 cases. Complaints related to the osteosynthesis material resulted in more frequent plate removal (p < 0.001). Complications were noted in 22 patients after plate removal. Duration of plate removal did not correlate with postoperative complications. In 69 patients, plates were removed without previous symptoms. Of these patients, postoperative complications were recorded in 15 cases. In patients with complaints after osteosynthesis, complications after plate removal occurred in seven (23.3%) patients. Ectropia developed significantly more often with increasing age (p < 0.05). CONCLUSION: Within the limitations of the study it seems that prophylactic plate removal is a treatment option that is not associated with an increased complication rate.
Collapse
Affiliation(s)
- Maximilian Riekert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany.
| | - Max-Philipp Lentzen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Jelle Tiddens
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Joachim E Zöller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Matthias Kreppel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Volker Schick
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Germany
| |
Collapse
|
5
|
Lentzen MP, Huebenthal V, Kaiser R, Kreppel M, Zoeller JE, Zirk M. A retrospective analysis of social media posts pertaining to COVID-19 vaccination side effects. Vaccine 2022; 40:43-51. [PMID: 34857421 PMCID: PMC8611612 DOI: 10.1016/j.vaccine.2021.11.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/13/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES With an uprising influence of social media platforms like Twitter and Instagram a multitude of worldwide accessible information is available. Since the beginning of COVID-19 pandemic the exchange of medical information about several topics related to this infectious disease and its vaccination has increased rapidly. The purpose of this investigation was to assess the content associated with COVID-19 vaccination and its side effects and evaluate its educational quality. METHODS We conducted this retrospective study to investigate 600 Twitter and Instagram posts by #covidvaccinesideeffects due to number of 'likes', comments, type of post, language, its purpose and source. In addition, posts were evaluated due to educational quality by three examiners of different educational levels. RESULTS The majority of posts showed 0 to 50 "likes" and 0 to 5 comments in English language. A comparison between Twitter and Instagram by the influence of application showed significant differences in number of posts and "likes" or comments (p < 0.05). The major post type were texts for Twitter (251; 83.7%) and videos for Instagram (104; 34.7%). While a majority of posts by #covidvaccinesideeffects report about the occurrence of side effects, the majority of them were mild and general COVID-19 vaccination feedback during the first 4 months was positive. But, only 3 to 7% were rated by "excellent" educational and validatable content. Interrater reliability between all three examiners presented a high concordance with 89% (p = 0.001). CONCLUSIONS This study presents an analysis of quantity and quality of social media content according to COVID-19 vaccinations and its side effects. It supports the deduction that most of the content on Twitter and Instagram is shared by patients and unclear sources and thus is limited informative. Nevertheless, influence of social media on medical information especially during COVID-19 pandemic is increasing and practitioners have to face its effect on their patients.
Collapse
Affiliation(s)
- Max-Philipp Lentzen
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Viola Huebenthal
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Rolf Kaiser
- Department for Virology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Joachim E Zoeller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| |
Collapse
|
6
|
Lentzen MP, Riekert M, Grozinger P, Zirk M, Nickenig HJ, Zöller JE, Kreppel M. Anatomical and volumetric analysis of fibro-osseous lesions of the craniofacial skeleton. J Craniomaxillofac Surg 2021; 49:1113-1118. [PMID: 34563422 DOI: 10.1016/j.jcms.2021.09.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Our study aimed to provide volumetric data relating to fibro-osseous lesions of the craniofacial skeleton, in order to highlight risk factors due to the different entities, and to guide clinical decisions for jeopardized patients. METHODS Volumetric measurements of osteomas and ossifying fibromas were performed by applying the open-source software ITK-Snap to cone-beam computed tomography images. DICOM datasets were imported, identified, and delineated using semiautomatic segmentation; this was then verified using manual segmentation. The volumes of the lesions were computed automatically in cubic millimeters using the program. For statistical investigations, descriptive statistics and independent Student t-tests were performed. Additionally, Pearson's correlation was applied as a bivariate analysis. Values of p < 0.05 were considered significant. RESULTS 45 patients (11 male and 34 female) were included in this study. The mean volumes were 10.02 ± 18.79 cm3 for osteomas and 4.80 ± 5.71 cm3 for ossifying fibromas (p = 0.016). Males (12.81 ± 20.38 cm3) presented significantly larger volumes than females (5.43 ± 10.32 cm3) (p = 0.042). With regard to shape, morphology, and affection of surrounding anatomical structures, irregular shape (p = 0.001; p = 0.037), multilocular morphology (p = 0.001; p = 0.037), nerve affection (p = 0.001; p = 0.002), tooth affection (p = 0.001; p = 0.594), cortical bone exceedance (p = 0.033; p = 0.001), and clinically visible symptoms (p = 0.004; p = 0.001) were statistically significantly associated with a larger volume of both entities. CONCLUSION Volumetric analysis revealed that osteomas significantly exceeded the mean size of ossifying fibromas, supporting the argument that special attention should be paid to this entity. In cases of difficult histopathological examination, lesions with irregular shape, multilocular morphology, nerve and tooth affection, cortical bone exceedance, and clinically visible symptoms should be considered for close clinico-radiological follow-up, irrespective of the entity.
Collapse
Affiliation(s)
- Max-Philipp Lentzen
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany.
| | - Maximilian Riekert
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Philipp Grozinger
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Hans-Joachim Nickenig
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| |
Collapse
|
7
|
Lentzen MP, Riekert M, Buller J, Grandoch A, Zirk M, Zoeller JE, Kreppel M. A volumetric study of mandibular condyles in orthognathic patients by semiautomatic segmentation. Oral Maxillofac Surg 2021; 26:205-212. [PMID: 34114116 PMCID: PMC9162966 DOI: 10.1007/s10006-021-00976-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
Purpose This study was conducted to elucidate volumetric data of mandibular condyles of orthognathic patients by analyzing cone beam computed tomography images based upon semiautomatic segmentation. Methods Cone beam computed tomography images of 87 patients with malocclusions were analyzed in this retrospective study. Patients were between 17 and 53 years old and diagnosed with Angle class I, II, or III malocclusion. By using the validated open-source software “ITK-SNAP,” the volumetric measurements of 174 mandibular condyles were performed. Volumetric analysis was performed according to intra-subject side differences by paired Student t test. In accordance to inter-subject side, gender, age and type of malocclusion differences bivariate analysis and ANOVA were applied. Results The mean volume for the right condyle was 1.378 ± 0.447 cm3, with a maximum of 2.379 cm3 and a minimum of 0.121 cm3. The mean volume for the left side was 1.435 ± 0.474 cm3, with a maximum of 3.264 cm3 and a minimum of 0.109 cm3. Bivariate analysis indicated a highly significant inter-subject difference between the volume of the left and right mandibular condyles (p < 0.01). Females had a significantly smaller condyle volume than males (p < 0.05 left condyle; p < 0.01 right condyle). Conclusion The fact that shape and volume of mandibular condyles show a high susceptibility to pathological alterations and particularly malocclusions makes a precise knowledge about volumetric changes indispensable. Our results show that significant inter-subject differences in condyle volume could be found with respect to the side and gender. Larger volumes could be assessed for the left condyle and for male patients.
Collapse
Affiliation(s)
- Max-Philipp Lentzen
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Maximilian Riekert
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Johannes Buller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Joachim E Zoeller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| |
Collapse
|
8
|
Riekert M, Schick VC, Schumacher L, Zöller JE, Kreppel M, Schick T. Volumetric Analysis and Clinical Outcome in 54 Patients with Retrobulbar Hematoma. J Oral Maxillofac Surg 2021; 79:1914-1920. [PMID: 34153252 DOI: 10.1016/j.joms.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Retrobulbar hematoma (RBH) is a rare but serious vision threatening emergency. We analyze the relationship between hematoma volume, visual impairment and outcome. METHODS Fifty-four patients with RBH receiving orbital decompression were retrospectively included. Volumetric analysis of RBH was performed by semi-automatic segmentation based on preoperative CT scans using ITK-SNAP software. Best corrected visual acuity (BCVA) measurements were obtained and correlated in 2 groups (no light perception (NLP), severe visual impairment) with the hematoma volume. RESULTS NLP was documented preoperatively in 5/28 and postoperatively in 9/43 patients. Preoperative NLP was significantly associated with a larger hematoma volume (P = .03) and higher hematoma/orbital volume ratio (P = .03). Postoperative severe visual impairment showed significant associations with a larger hematoma volume (P = .02) as well as higher hematoma/orbital volume ratio (P = .02). CONCLUSION Eyes with severe visual impairment and large hematoma volumes preoperatively are at high risk of permanent vision loss. Hematoma volume calculation might represent an additional prognostic parameter for visual outcome after RBH.
Collapse
Affiliation(s)
- Maximilian Riekert
- Department of Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Volker C Schick
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Laura Schumacher
- Department of Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tina Schick
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; MVZ Augenärztliches Diagnostik- und Therapiecentrum Siegburg GmbH, Siegburg, Germany
| |
Collapse
|
9
|
Lentzen MP, Buller J, Riekert M, Grandoch A, Kreppel M, Zöller JE, Zirk M. Bisphosphonate application and volumetric effects on MRONJ lesions. J Craniomaxillofac Surg 2021; 49:501-507. [PMID: 33853745 DOI: 10.1016/j.jcms.2021.01.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/27/2020] [Accepted: 01/31/2021] [Indexed: 01/22/2023] Open
Abstract
The purpose of this investigation was to analyze the volume of medication-related osteonecrosis of the jaw (MRONJ) lesions by semi-automatic segmentation of cone-beam computed tomography images, and correlate the results with the underlying diseases and applied medication. MRONJ lesions detected in cone-beam computed tomography images were assessed. The open-source software ITK-Snap enabled volumetric measurements of MRONJ lesions based on semi-automatic segmentation. Results were analyzed according to necrosis volume, localization, and gender. In addition, the underlying disease and the type of application of antiresorptive medication were investigated. Cone-beam computed tomography images of 66 patients were studied. 34 male and 32 female patients were included, with ages ranging from 50 to 93 years at the time of diagnosis. The mean volume was 993.24 ± 620.94 mm3: 484.73 ± 230.97 mm3 for the upper jaw and 1084.04 ± 625.74 mm3 for the lower jaw. The results indicated statistically significant differences between lesions of the upper and lower jaw, regardless of gender (p = 0.003). The analysis of differences between males and females did not show any significant results (p = 0.464), although males presented slightly larger lesions than females. With regard to the underlying disease, patients with osteoporosis presented larger volumes, whereas patients with malignant tumors presented smaller volumes. Nevertheless, no statistically significant differences according to the underlying disease (p = 0.313) were detected. However, patients with intravenous (iv) application showed statistically significantly larger lesions than patients who underwent oral or subcutaneous (s.c.) applications (p = 0.004). It seems that the osteonecrosis volume correlates with the applied antiresorptive agents. Larger MRONJ lesions should be expected in patients who receive intravenous antiresorptive therapy.
Collapse
Affiliation(s)
- Max-Philipp Lentzen
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany.
| | - Johannes Buller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Maximilian Riekert
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| |
Collapse
|
10
|
Weckx A, Grochau KJ, Grandoch A, Backhaus T, Zöller JE, Kreppel M. Survival outcomes after surgical treatment of oral squamous cell carcinoma. Oral Dis 2020; 26:1432-1439. [PMID: 32428375 DOI: 10.1111/odi.13422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/21/2020] [Accepted: 05/08/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify the clinicopathological parameters that influence survival in patients with oral squamous cell carcinoma, in order to allow for the development of individualized surveillance programmes and reduce the delay in diagnosis of recurrence. MATERIALS AND METHODS Retrospective chart review of 553 patients with a treatment-naïve primary oral squamous cell carcinoma, who underwent primarily curative intended surgery. Exclusion criteria were neoadjuvant radio(chemo)therapy, follow-up < 1 year, perioperative death, inoperable disease, synchronous multiple malignancies and inadequate information on clinicopathological parameters. RESULTS The clinicopathological factors that influence overall survival, disease-free survival and locoregional control were calculated. In the multivariate survival analysis, the occurrence of recurrence, presence of extracapsular spread, T- and N-classification were shown to be independent risk factors for overall survival. CONCLUSION The identification of these risk factors can lead to the development of individualized follow-up programmes based on risk stratification. This allows for the earliest possible diagnosis of relapse which is essential to offer the patient a realistic second treatment chance and to improve survival rates.
Collapse
Affiliation(s)
- Annelies Weckx
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Kathrin J Grochau
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Tim Backhaus
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
11
|
Riekert M, Kreppel M, Schier R, Zöller JE, Rempel V, Schick VC. Postoperative complications after bimaxillary orthognathic surgery: A retrospective study with focus on postoperative ventilation strategies and posterior airway space (PAS). J Craniomaxillofac Surg 2019; 47:1848-1854. [PMID: 31810851 DOI: 10.1016/j.jcms.2019.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/29/2019] [Accepted: 11/18/2019] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the impact of extubation time on postoperative complications in patients undergoing bimaxillary orthognathic surgery. We therefore retrospectively compared the effect of early extubating (EE) in the operating room versus delayed extubating (LE) on the intensive care unit (ICU) regarding postoperative complications and length of ICU/hospital stay (LOICUS/LOHS). Furthermore, we analyzed the influence of the PAS change on postoperative complications. METHODS The clinical data of 117 patients were retrospective analyzed regarding postoperative complications using Clavian-Dindo Classification. Volumetric calculations of the pre- and postoperative PAS were conducted using ITK-SNAP software. The Fisher's exact test was performed to evaluate the significance of differences between categorical variables. Continuous variables were analyzed using the Mann-Whitney U-Test or the Kruskal-Wallis one-way analysis of variance. Regression analysis was used estimating predictors for postoperative complications. RESULTS EE led to significant shortening of LOICUS (p < 0.001) and LOHS (p = 0.023). In total, we recorded 38 complications (minor n = 30; major n = 8) within the hospital stay. Complication rates were without significant differences with respect to the postoperative ventilation strategy. Large changes in PAS volume led to an increase in the major complication rates (p = 0.031). Increase or decrease of PAS was independent from postoperative complication rates (p = 1.000). Higher body mass index (p = 0.04) and a higher ASA PS score (p = 0.016) were associated with increased major complication rates. CONCLUSION Early extubation after surgery is a safe procedure and is associated with a reduced LOICUS and LOHS. Complications seem to occur more frequently in marked changes of the PAS and should be considered in perioperative risk stratification.
Collapse
Affiliation(s)
- Maximilian Riekert
- Department of Oral and Craniomaxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. Joachim E. Zöller), University Hospital of Cologne, Germany.
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. Joachim E. Zöller), University Hospital of Cologne, Germany
| | - Robert Schier
- Department of Anaesthesiology and Intensive Care Medicine, (Head: Prof. Dr. Bernd W. Böttiger), University Hospital of Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. Joachim E. Zöller), University Hospital of Cologne, Germany
| | - Vadim Rempel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. Joachim E. Zöller), University Hospital of Cologne, Germany
| | - Volker C Schick
- Department of Anaesthesiology and Intensive Care Medicine, (Head: Prof. Dr. Bernd W. Böttiger), University Hospital of Cologne, Germany
| |
Collapse
|
12
|
Nickenig HJ, Safi AF, Matta RE, Zöller JE, Kreppel M. 3D-based full-guided ridge expansion osteotomy – A case report about a new method with successive use of different surgical guides, transfer of splitting vector and simultaneous implant insertion. J Craniomaxillofac Surg 2019; 47:1787-1792. [DOI: 10.1016/j.jcms.2019.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/11/2019] [Accepted: 07/21/2019] [Indexed: 11/26/2022] Open
|
13
|
Zirk M, Zalesski A, Peters F, Kreppel M, Zinser M, Zöller JE. Oral recipient site infections in reconstructive surgery - impact of the graft itself and the perioperative antibiosis. Clin Oral Investig 2019; 24:1599-1605. [PMID: 31643002 DOI: 10.1007/s00784-019-03078-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study was designed to assess the influence of peri/post-operative antibiotic prophylaxis (POABP) and the reconstructive graft itself on recipient sites infections in head and neck surgery. MATERIALS AND METHODS In this retrospective cohort study, 322 consecutive patients with reconstructive surgery were investigated. The primary objective was to analyze the differences of commonly applied reconstructive grafts on the occurrence of oral recipient site infections. Moreover, differences of POABP regimes (namely: ampicillin/sulbactam, 2nd generation cephalosporins, clindamycin) and antibiotic alternatives were investigated. In addition, patients' length of in-hospital stay was analyzed in regard to reconstructive graft and POABP regime. RESULTS The free radial forearm flap and split-thickness skin graft presented significantly less recipient site infections and shorter length of in-hospital stays (LOS) in comparison to further six reconstructive technique with pedicled tissue transfer or bone transfers. LOS was significantly shorter for patients with ampicillin/sulbactam than with 2nd generation cephalosporins as POABP. 91% of the harvested pathogens (n=193) were susceptible to the combination of 2nd and 3rd generation cephalosporins. Secondly, 92 out 113 (81%) harvested pathogens presented susceptibility to moxifloxacin. CONCLUSION Smaller tissue transfers are less prone to infections of the recipient site and present low LOS. For an POABP regime, the combination of 2nd and 3rd generation cephalosporins presents substantial results in recipient site infections. In cases of allergy, potential pathogens show adequate susceptibility to moxifloxacin. CLINICAL RELEVANCE A combination of 2nd and 3rd generation cephalosporins may be used to prevent recipient sites in head and neck surgery.
Collapse
Affiliation(s)
- Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
| | - Artjom Zalesski
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Franziska Peters
- Department of Dermatology, University of Cologne, Cologne, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Max Zinser
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| |
Collapse
|
14
|
Riekert M, Kreppel M, Zöller JE, Zirk M, Annecke T, Schick VC. Severe odontogenic deep neck space infections: risk factors for difficult airways and ICU admissions. Oral Maxillofac Surg 2019; 23:331-336. [PMID: 31115831 DOI: 10.1007/s10006-019-00770-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE The purpose of this retrospective study was to evaluate perioperative risk factors concerning difficult airway management, primary tracheostomy, and need for intensive care unit (ICU) admission in severe odontogenic space infections. METHODS Perioperative risk factors were retrospectively analyzed in 499 cases. Fisher's exact test and analysis of variance were performed to analyze associations between categorical and continuous variables. Univariate regression analysis was used for estimating predictors for ICU admission. A risk model for ICU admission was performed using multivariate regression analysis. Area-under-the-curve (AUC) was calculated by receiver-operating-characteristic (ROC) curve. RESULTS Airway securing in patients with restricted mouth opening led to significant use of the video laryngoscope (p < 0.001) or fiberoptic bronchoscope (p < 0.001). The use of fiberoptic bronchoscopy was significantly increased in patients with dysphagia (p = 0.005) and dyspnea (p = 0.04). Four patients (0.8%) needed primary tracheostomy. ICU admission was significantly associated with higher levels of C-reactive protein (CRP, p = 2.78 × 10-5), white blood cell count (WBC, p = 0.003), dyspnea (p = 9.95 × 10-6), and higher body mass index (BMI, p = 0.0003). American Society of Anesthesiologists physical status (ASA PS) class III patients (p = 0.04) and the need for the use of a video laryngoscopy (p = 0.003) or fiberoptic bronchoscopy (p = 6.58 × 10-5) resulted in a more frequent ICU admission. The AUC of the model was 0.897. CONCLUSION Difficult airway management was mainly dependent on limited mouth opening and elevated CRP. Elevated CRP, BMI, ASA PS III, and dyspnea were important risk factors for ICU admission. These predictors should be considered preoperatively for proper planning and preparation.
Collapse
Affiliation(s)
- Maximilian Riekert
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50924, Cologne, Germany
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50924, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50924, Cologne, Germany
| | - Matthias Zirk
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50924, Cologne, Germany
| | - Thorsten Annecke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Volker C Schick
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| |
Collapse
|
15
|
Grandoch A, Nestmann F, Kreppel M, Buller J, Borggrefe J, Zirk M, Zöller JE. Comparison of MRI with dedicated head and neck signal amplification coil and cone beam computed tomography: MRI is a useful tool in diagnostics of cranio-facial growth disorders. J Craniomaxillofac Surg 2019; 47:1827-1833. [PMID: 31439410 DOI: 10.1016/j.jcms.2019.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/14/2019] [Accepted: 07/21/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) shows excellent image quality for the depiction of soft tissues and is therefore an important imaging technique in medical diagnostics. However, the practical simultaneous presentation of hard and soft tissue structures of the mouth, jaw and facial area is not fully satisfactory at this time. We investigated the image quality of 1.5 T MRI using a dedicated signal amplifying coil for the application in the oral and maxillofacial field of and compared it with cone beam computed tomography (CBCT). We hypothesized that imaging quality for growth disorders of the facial skull does not differ significantly between the two imaging techniques. MATERIALS AND METHODS 12 patients were consecutively enrolled into this study between 01/2016 and 12/2017. Patients received diagnostic imaging for clinical indications using 1,5 T MRI using a dedicated head and neck coil for signal amplification as well as an CBCT. For each patient 5 different MRI sequences and one CBCT protocol were assessed. Images were evaluated by a radiologist and a dentist in consensus. On the basis of 51 anatomical structures and orthodontic, cephalometric reference points, the five datasets were subjectively rated and compared to the CBCT dataset. RESULTS Patient age was in the range of 19-78 years. 2614 (69.8%) out of 3744 possible valuations were assessable. Compared to CBCT, MRI images were rated to have a superior image quality of presentation for 42 out of 51 anatomic structures (p < 0.05). Notably, 5 out of 51 structures were not assessable due to missing values. T1-weighted MRI images were rated superiorly to T2-weighted images in displaying anatomically relevant landmarks in the oral and maxillofacial field. MRI datasets were inferior in imaging cephalometric and orthodontic reference points in comparison to CBCT images. CONCLUSION In conclusion, this pilot study demonstrates that radiation-free dental MRI enables a reliable detection of important anatomical structures. Thus, the signal amplified MRI presents a radiation-free imaging alternative to established CBCT in craniofacial growth disorders protocols. However, imaging quality in MRI datasets remains inferior to CBCT images for cephalometric and orthodontic reference points.
Collapse
Affiliation(s)
- Andrea Grandoch
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany.
| | - Florian Nestmann
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - Johannes Buller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - Jan Borggrefe
- Department for Diagnostic and Interventional Radiology, University of Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| |
Collapse
|
16
|
Rokohl AC, Koch KR, Kabbasch C, Kreppel M, Lüers JC, Grau S, Heindl LM. [Importance of interdisciplinary collaboration for optimal treatment of orbital tumors]. HNO 2019; 67:528-533. [PMID: 30941456 DOI: 10.1007/s00106-019-0659-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Optimal treatment of tumors with orbital invasion may exceed the competences of an individual medical specialty and require interdisciplinary cooperation. The aim of this article is to present an interdisciplinary treatment concept based on the examples of intraorbital hemangioma and squamous cell carcinoma of the paranasal sinuses infiltrating the orbit. In addition to a detailed medical history and a complete ophthalmological examination, a detailed imaging technique with standardized echography and tomography methods such as orbital thin-slice CT and/or in many cases MRI is essential for the primary classification of an intraorbital pathology. Depending on the type of pathology, a purely surgical procedure involving various disciplines such as ophthalmology, otorhinolaryngology, maxillofacial surgery, neurosurgery, and pathology, or an interdisciplinary treatment regimen including (neo)adjuvant radiotherapy or chemotherapy is necessary. Orbital tumors have a wide range of potential pathologies, requiring complex surgical procedures and multimodal therapies. In case of infiltration of the paranasal sinuses or intracranial structures, an interdisciplinary team including neuroradiologists, oral-maxillofacial surgeons, otorhinolaryngologists, neurosurgeons, radiation therapists, ophthalmologists, pathologists, oncologists, and psycho-oncologists is essential for successful treatment.
Collapse
Affiliation(s)
- A C Rokohl
- Universitätsklinik Köln, Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - K R Koch
- Universitätsklinik Köln, Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - C Kabbasch
- Universitätsklinik Köln, Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universität zu Köln, Köln, Deutschland
| | - M Kreppel
- Universitätsklinik Köln, Klinik für Mund-Kiefer-Gesichtschirurgie, Universität zu Köln, Köln, Deutschland
| | - J-C Lüers
- Universitätsklinik Köln, Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln, Köln, Deutschland
| | - S Grau
- Universitätsklinik Köln, Zentrum für Neurochirurgie, Universität zu Köln, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland
| | - L M Heindl
- Universitätsklinik Köln, Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland
| |
Collapse
|
17
|
Weckx A, Riekert M, Grandoch A, Schick V, Zöller JE, Kreppel M. Time to recurrence and patient survival in recurrent oral squamous cell carcinoma. Oral Oncol 2019; 94:8-13. [PMID: 31178216 DOI: 10.1016/j.oraloncology.2019.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/28/2019] [Accepted: 05/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Tumour relapse remains one of the major problems in managing oral squamous cell carcinoma (OSCC) with mortality rates of up to 92%. Early recurrences have a worse prognosis than late relapses. However, few has been written about the influence of clinicopathological parameters on the timing of recurrence and the patient survival. MATERIALS AND METHODS Retrospective chart review of 159 patients with an OSCC recurrent disease. Exclusion criteria were neoadjuvant chemoradiotherapy, follow-up <6 weeks, perioperative death, second primaries and inadequate information on clinicopathological parameters. Statistical analysis was performed using univariate and multivariate analysis. RESULTS A significant correlation was found in the χ2-analysis between the timing of recurrence and the margin status (p = 0.020), lymph node ratio (p = 0.030) and grading (p = 0.003) of the primary tumour. In the multivariate survival analysis, the timing of recurrence (p < 0.001), margin status of the primary tumour (p = 0.023), presence of extracapsular spread in the primary tumour (p = 0.003) and performance of a salvage treatment (p < 0.001) were shown to be independent risk factors for overall survival. CONCLUSION For patients with a recurrent OSCC, the time to recurrence, margin status, extracapsular spread and the performance of a salvage treatment are independent prognostic factors for overall survival. Furthermore, a significant association exists between the moment of recurrence and the lymph node ratio, the margin status and grading of the primary tumour. This knowledge can allow for the development of individualised surveillance programs and like this, an earlier diagnosis and better second treatment chance in the case of a recurrence.
Collapse
Affiliation(s)
- Annelies Weckx
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany.
| | - Maximilian Riekert
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany
| | - Volker Schick
- Department for Anesthesiology and Intensive Care, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany
| |
Collapse
|
18
|
Noetzel N, Fienitz T, Kreppel M, Zirk M, Safi AF, Rothamel D. Osteotomy speed, heat development, and bone structure influence by various piezoelectric systems-an in vitro study. Clin Oral Investig 2019; 23:4029-4041. [PMID: 30826919 DOI: 10.1007/s00784-019-02838-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this in vitro study was to evaluate osteotomy speed, heat development, and bone structure influence from osteotomies performed by various piezoelectric devices and insert tips. These devices and tips were compared among each other with regard to conventional rotatory and oscillating systems with special focus on the insert tip design and thickness. MATERIAL AND METHODS The osteotomies were conducted on porcine ribs utilizing 12 different insert tips (straight and angulated) and three conventional systems. After time and temperature measurements, histological analysis was carried out. Light microscopy was used to evaluate the roughness of the osteotomic surface and to search for indications of thermal bone necrosis. A special software analyzing tool was employed to determine cutting width (mm) and debris (%). RESULTS All piezoelectric tips created smooth cuts. Cutting widths in general were wider than the actual insert tip size with a tendency for narrow straight insert tips producing relatively wide osteotomies, whereas narrow angulated inserts produced relatively small osteotomies. None of the samples demonstrated distinct indication of necrosis. Overall, there was only a small amount of debris in all osteotomy gaps. Conventional rotatory saws were faster and created less heat compared to all tested piezoelectric systems. Straight tips proved faster osteotomy speed than angulated tips. Thin insert tips indicated to have a positive correlation to osteotomy time and performed faster than conventional microsaw. The average temperature rise was lower when using conventional systems, but critical exceeding temperatures were only observed in short-time exceptional cases. In general, temperature rise was less when using angulated inserts. CONCLUSION All tested tips are appropriate for bone surgery. Only small differences were found among the piezoelectric insert tips. Although conventional rotatory systems in general performed faster osteotomies, special designed and thin piezoelectric insert tips seem to have a positive influence on osteotomy speed. Ultimately, none of the tested devices or inserts combined all best features of speed, heat development, bone structure influence, and safety. CLINICAL RELEVANCE Narrow and straight piezoelectric insert tips demonstrated reduced osteotomy times. Nevertheless, a combination of conventional and piezoelectric systems in clinical practice might be the best way to work time-efficient, patient-oriented, and safe. The choice of instrument should be based on clinical experience of the user and should be evaluated individually depending on the case.
Collapse
Affiliation(s)
- Nicolas Noetzel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Tim Fienitz
- Department for Oral and Maxillofacial Plastic Surgery, University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Matthias Kreppel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Ali- Farid Safi
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Daniel Rothamel
- Department for Oral and Maxillofacial Plastic Surgery, University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| |
Collapse
|
19
|
Ebrahimi A, Gil Z, Amit M, Yen TC, Liao CT, Chaturvedi P, Agarwal JP, Kowalski LP, Köhler HF, Kreppel M, Cernea CR, Brandao J, Bachar G, Villaret AB, Fliss DM, Fridman E, Robbins KT, Shah JP, Patel SG, Clark JR. Depth of invasion alone as an indication for postoperative radiotherapy in small oral squamous cell carcinomas: An International Collaborative Study. Head Neck 2019; 41:1935-1942. [PMID: 30801885 DOI: 10.1002/hed.25633] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/02/2018] [Accepted: 12/19/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We aimed to investigate whether depth of invasion (DOI) should be an independent indication for postoperative radiotherapy (PORT) in small oral squamous cell carcinomas (SCC). METHODS Retrospective analysis of DOI (<5, 5 to <10, ≥10 mm) and disease-specific survival (DSS) in a multi-institutional international cohort of 1409 patients with oral SCC ≤4 cm in size treated between 1990-2011. RESULTS In patients without other adverse factors (nodal metastases; close [<5 mm] or involved margins), there was no association between DOI and DSS, with an excellent prognosis irrespective of depth. In the absence of PORT, the 5-year disease-specific mortality was 10% with DOI ≥10 mm, 8% with DOI 5-10 mm, and 6% with DOI <5 mm (P = .169), yielding an absolute risk difference of only 4%. CONCLUSION The deterioration in prognosis with increasing DOI largely reflects an association with other adverse features. In the absence of these, depth alone should not be an indication for PORT outside a clinical trial.
Collapse
Affiliation(s)
- Ardalan Ebrahimi
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.,Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ziv Gil
- Laboratory for Applied Cancer Research, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Otolaryngology Rambam Medical Center, Rappaport School of Medicine, the Technion, Israel institute of technology, Haifa, Israel
| | - Moran Amit
- Laboratory for Applied Cancer Research, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Otolaryngology Rambam Medical Center, Rappaport School of Medicine, the Technion, Israel institute of technology, Haifa, Israel
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pankaj Chaturvedi
- Department of Head & Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Luiz P Kowalski
- Department of Head & Neck Surgery, Hospital A.C. Camargo, São Paulo, Brazil
| | - Hugo F Köhler
- Department of Head & Neck Surgery, Hospital A.C. Camargo, São Paulo, Brazil
| | - Matthias Kreppel
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Claudio R Cernea
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Jason Brandao
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Gideon Bachar
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Israel
| | | | - Dan M Fliss
- Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eran Fridman
- Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Kevin Thomas Robbins
- Division of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Jatin P Shah
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Snehal G Patel
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Medical School, University of New South Wales, Sydney, New South Wales, Australia.,Medical School, Sydney University, Sydney, New South Wales, Australia
| | | |
Collapse
|
20
|
Buller J, Kreppel M, Maus V, Zirk M, Zöller JE. Risk of frontal sinus anterior table fractures after craniofacial trauma and the role of anatomic variations in frontal sinus size: A retrospective case-control study. J Craniomaxillofac Surg 2019; 47:611-615. [PMID: 30718214 DOI: 10.1016/j.jcms.2019.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/09/2018] [Accepted: 01/11/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Purpose of this study was to evaluate a probable risk of frontal sinus size for traumatic depressed anterior table fractures in patients with similar forehead trauma. METHODS We conducted a retrospective case-control study with a case group of consecutive treated patients with displaced frontal sinus anterior table fractures. The control group was randomly sampled from patients who presented with a blunt forehead trauma in our institution's emergency unit. In computed tomography data sets, all patients' frontal sinus size was categorized by Guerram's classification that is defined as aplasia, hypoplasia, medium-size and hyperplasia. Odds for prevalence of the sinus types as well as sinus total width and height were compared between both groups. RESULTS In total, 47 cases and 93 controls were identified. Hyperplasia in the case group had an odds ratio of 46:1 (p < 0.001) compared to the controls. Mean sinus width (73 mm vs. 46 mm; p < 0.001) and sinus height (30 mm vs. 15 mm; p < 0.001) were larger in the case group. CONCLUSION Depressed traumatic fractures of the anterior table are an injury with a high risk specific for enlarged frontal sinus sizes. Anatomy is the predictive factor for this mode of craniofacial trauma.
Collapse
Affiliation(s)
- Johannes Buller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Volker Maus
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias Zirk
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
21
|
Grochau KJ, Safi AF, Drebber U, Grandoch A, Zöller JE, Kreppel M. Podoplanin expression in oral leukoplakia─a prospective study. J Craniomaxillofac Surg 2019; 47:505-509. [PMID: 30638740 DOI: 10.1016/j.jcms.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/18/2018] [Accepted: 12/06/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The aim of this prospective work was to examine oral leukoplakia for their podoplanin expression to determine whether podoplanin expression is associated with the degree of dysplasia. MATERIALS AND METHODS We took biopsy samples from 50 patients with oral leukoplakia in 2013. The preparations studied by immunohistochemistry were analyzed in correlation with the degree of dysplasia and other clinicopathological variables. RESULTS The Chi-square test showed a significant correlation between podoplanin expression and the degree of dysplasia according to the squamous intraepithelial neoplasia (SIN) classification (p = 0.033). Also, a significant association between age grouping and podoplanin expression was found. We were able to show that the distribution is the same for both age groups in relation to the score of podoplanin expression (p = 0.003). CONCLUSION In a comparable retrospective work of our working group, it could be shown that podoplanin is a reliable predictive marker for the assessment of the risk of malignant transformation. The present work was able to substantiate the assumption that podoplanin not only plays an important role in the context of malignant degeneration but also exerts a major influence in advance.
Collapse
Affiliation(s)
- Kathrin J Grochau
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
| | - Ali-Farid Safi
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Uta Drebber
- Department of Pathology, University of Cologne, Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
22
|
Kocsis C, Sommerlath Sohns JM, Graf I, Dreiseidler T, Kreppel M, Rothamel D, Zinser M, Sommerlath Sohns HC, Derlin T, Braumann B, Zöller JE, Ritter L. Incidental findings on craniomaxillofacial cone beam computed tomography in orthodontic patients. Int J Comput Dent 2019; 22:149-162. [PMID: 31134221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Cone beam computed tomography (CBCT) in orthodontics is increasingly used for detecting impacted or ectopic teeth or for orthognathic and cleft lip and palate treatment. Incidental findings (IFs) are frequently encountered and often relevant. The aim of this study was to detect the prevalence of relevant pathologies on CBCT scans of orthodontic patients. METHODS Over a 6-year period, incidental imaging findings were analyzed in 345 CBCT scans (181 men; 164 women; age 16.3 ± 8.4 years), and subdivided into dental (Group 1), skeletal (Group 2), sinunasal (Group 3), and infrequent other pathologies (Group 4). RESULTS A total of 502 IFs were detected in 345 patients (1.4 IFs per patient, on average). Most IFs were found in Group 1 (358 IFs; 71.3%), followed by Group 2 (129 IFs; 25.7%), Group 3 (14 IFs; 2.8%), and Group 4 (1 IF; 0.2%). There were 119 (34.5%) patients with a missing wisdom tooth, 94 (27.3%) with dental aplasia, 71 (20.6%) with dislocations, 33 (9.6%) with partial opacifications, and 27 (7.8%) with signs of sinusitis. CONCLUSIONS This study found that IFs in orthodontic CBCT scans are frequently encountered, even in younger orthodontic patients. When interpreting CBCT scans, orthodontists should be aware of potential relevant IFs that may require further investigation, change patients' treatment or affect their quality of life.
Collapse
|
23
|
Kauke M, Safi AF, Grandoch A, Nickenig HJ, Zöller J, Kreppel M. Image segmentation-based volume approximation-volume as a factor in the clinical management of osteolytic jaw lesions. Dentomaxillofac Radiol 2018; 48:20180113. [PMID: 30216090 DOI: 10.1259/dmfr.20180113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Size characterization of osteolytic jaw lesions (OJL), in particular of neoplastic nature, is heterogeneously performed and lacks standardization in the medical literature and clinical practice. An OJL's volume holds promise as a surrogate for treatment response and prognosis. We comparatively evaluate various methods for size characterization of odontogenic OJLs. METHODS We retrospectively performed semiautomatic image segmentation of CBCT data sets for volume approximation of neoplastic (51) and non-neoplastic odontogenic OJLs (100). We assessed the three greatest orthogonal diameters and calculated the volume using the cuboid- and ellipsoid-formula. Image segmentation was carried out using ITK-SNAP. Image segmentation-based volume approximation served as reference. Intra- and inter-rater variability were evaluated at hand of Bland-Altman-Analysis and dice similarity coefficient (DSC). RESULTS Concerning the intrarater variability, we found the DSC to be highest for image segmentation-based volume approximation, simultaneously showing the tightest limits of agreement and greatest reliability. The cuboid formula showed consistent overestimation of the lesion's volume with a percent mean difference of -52 % (upper and lower limits of agreement +8.57 % and -112.63%, respectively). In mean, the ellipsoid formula underestimated the lesion's volume by 10.1% (upper and lower limits of agreement +76.8% and -56.6%, respectively). Inter rater variability was higher for formula-based volume approximation. Volume and multilocularity (p = 0.001) correlate with aggressiveness and growth potential. CONCLUSIONS Segmentation-based volume approximation holds great promise for patient individualized treatment planning and clinical management. The data suggest that maximum tumour diameter-based size characterization, especially the cuboid-formula and the maximum diameter alone, should not be recommended.
Collapse
Affiliation(s)
- Martin Kauke
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Ali-Farid Safi
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Hans-Joachim Nickenig
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
24
|
Kreppel M, Zöller J. Ameloblastoma-Clinical, radiological, and therapeutic findings. Oral Dis 2018; 24:63-66. [PMID: 29480593 DOI: 10.1111/odi.12702] [Citation(s) in RCA: 36] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 12/15/2022]
Abstract
Ameloblastoma are the most common odontogenic tumor. As they usually do not form metastasis, they are considered as benign tumors with a locally invasive growth pattern and destruction of the jaws and the surrounding tissue (Oral Diseases, 23, 2017, 199). This article focuses on clinical, radiological, and therapeutic findings, which may influence diagnosis and treatment of ameloblastoma in the future.
Collapse
Affiliation(s)
- M Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - J Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
25
|
Zirk M, Zalesski A, Peters F, Dreiseidler T, Buller J, Kreppel M, Zöller JE, Zinser M. Prevention and management of bacterial infections of the donor site of flaps raised for reconstruction in head and neck surgery. J Craniomaxillofac Surg 2018; 46:1669-1673. [DOI: 10.1016/j.jcms.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 12/01/2022] Open
|
26
|
Rempel V, Safi A, Drebber U, Nickenig H, Neugebauer J, Zöller J, Kreppel M. The prognostic relevance of lymph node ratio in patients with oral squamous cell carcinoma treated with neoadjuvant therapy regimen and radical surgery. J Craniomaxillofac Surg 2018; 46:1659-1663. [DOI: 10.1016/j.jcms.2018.05.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/03/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022] Open
|
27
|
Kreppel M, Kauke M, Safi AF, Grandoch A, Pocek-Behn N, Nickenig HJ, Zöller J. Clinical evaluation of non-syndromic scaphocephaly surgically corrected with the procedure of total vertex craniectomy. J Craniomaxillofac Surg 2018; 46:1465-1469. [PMID: 29960814 DOI: 10.1016/j.jcms.2018.05.057] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 05/16/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022] Open
Abstract
The present investigation constitutes a retrospective evaluation of the outcome in children who received surgical correction of a scaphocephalic phenotype by median total vertex craniectomy. Between September 2009 and September 2015, a total of 35 infants with non-syndromic scaphocephaly were treated according to the same standardized operative technique of total vertex craniectomy by a single surgeon approach. At the time of surgery, the patients were between 3 and 12 months of age, with a median of 5 months. The mean duration of the procedure was 94 min. The duration of postoperative follow-up was a mean of 24 months (range 6-49 months). A total of 34 (97%) patients were successfully treated by total vertex craniectomy and were thus classified as category I according to the Whitaker score. Only one individual was assigned to category IV, necessitating secondary major craniofacial corrective surgery. Aesthetic outcomes were excellent in 34 cases and poor in one case. No major complication occurred. The reoperation rate was 3%. The surgical method we present herein is a wide median craniectomy which can be applied in young individuals with non-syndromic single-suture scaphocephaly.
Collapse
Affiliation(s)
- Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Germany.
| | - Martin Kauke
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Germany
| | - Ali-Farid Safi
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Germany
| | - Nina Pocek-Behn
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Germany
| | - Hans-Joachim Nickenig
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Germany
| | - Joachim Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Germany
| |
Collapse
|
28
|
Buller J, Maus V, Grandoch A, Kreppel M, Zirk M, Zöller JE. Frontal Sinus Morphology: A Reliable Factor for Classification of Frontal Bone Fractures? J Oral Maxillofac Surg 2018; 76:2168.e1-2168.e7. [PMID: 30009786 DOI: 10.1016/j.joms.2018.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The frontal sinus shows a wide range of morphologic variations. The aim of this study was to evaluate the influence of frontal sinus size on fracture characteristics in frontal bone trauma. MATERIALS AND METHODS In this cross-sectional study, data from patients with traumatic fractures of the frontal bone were retrospectively collected from the institution's database. Radiometric analysis of computed tomography and cone-beam computed tomography datasets was performed. Frontal sinus size was measured as variables of height, width, and depth. The secondary predictor was morphologic sinus type according to Guerram's classification: hyperplasia, medium size, hypoplasia, or aplasia of the frontal sinus. To determine outcomes, we classified fractures into the following categories: fracture isolated to the anterior table, combined fractures of the anterior and posterior tables, fracture isolated to the posterior table, and frontal bone fracture without sinus involvement. Further study variables were patients' demographic characteristics, combined midfacial fractures, orbital rim involvement, fracture displacement, and surgical approach. For statistical analysis, fracture types were assessed for frontal sinus metric size and morphologic type using bivariate tests with P < .05 defined as significant. RESULTS We enrolled 53 consecutive patients with a mean age of 35 years; male patients comprised 91%. Fracture types differed significantly in sinus width and height (both P < .001), as well as depth (P = .002). Frontal sinus morphology was hyperplastic in 66%, medium in 30.2%, and hypoplastic in 3.8%. Patients with a hyperplastic frontal sinus had an increased likelihood of isolated anterior table fractures (odds ratio, 6.0; P = .007) compared with medium-sized types. Fractures without sinus involvement were more likely in hypoplastic and medium types (P < .001). CONCLUSIONS The morphology of the frontal sinus determines the probability of fracture types from craniofacial trauma. Thus the frontal sinus size appears to be a major factor for frontal bone resistance to traumatic force impingement.
Collapse
Affiliation(s)
- Johannes Buller
- Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
| | - Volker Maus
- Senior Physician, Department of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany; and Radiologist, Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea Grandoch
- Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Assistant Professor, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Zirk
- Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Professor and Head, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
29
|
Grandoch A, Kreppel M, Safi AF, Zirk M, Zöller JE. Laterocaudal approach to the inferior rim of the orbit. J Craniomaxillofac Surg 2018; 46:1218-1222. [PMID: 29907433 DOI: 10.1016/j.jcms.2018.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Fractures of the orbital floor and orbital rim are frequently treated in maxillofacial departments. Various approaches to the orbital floor are described in the literature. We present an investigation of a modified subciliary approach (laterocaudal approach) with respect to its feasibility and clinical outcome. MATERIALS AND METHODS Our retrospective study investigated 130 well-documented cases of patients with orbital floor fractures who received surgical reconstruction using a laterocaudal approach, and compared the results with the current literature, with a focus on subciliary and transconjunctival approaches. RESULTS 111 patients (85.4%) presented a Vancouver scar scale (VSS) of 0.14 patients (10.8%) had a VSS score of 1. No patients had a VSS of 2. Just five patients (3.8%) had a slight ectropium and therefore a VSS score of 3. CONCLUSION The laterocaudal approach can be safely performed and presents advantages over comparable techniques such as the subciliary and transconjunctival approaches if performed correctly.
Collapse
Affiliation(s)
- Andrea Grandoch
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany.
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - Ali-Farid Safi
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| |
Collapse
|
30
|
Buller J, Zirk E, Kreppel M, Grandoch A, Maus V, Zirk M, Zöller JE. Radiomorphometric analysis of isolated zygomatic arch fractures: A comparison of classifications and reduction outcomes. J Craniomaxillofac Surg 2018; 46:1252-1257. [PMID: 29884318 DOI: 10.1016/j.jcms.2018.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/05/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022] Open
Abstract
PURPOSE Although different proposals have been made to categorize isolated zygomatic arch fractures (ZAF), an investigation about fracture type and clinical outcome has not been published. In this study, we analyzed the geometric fracture morphology in isolated ZAF and provide a survey of reduction outcomes in accordance with 4 independent classifications. MATERIALS AND METHODS Geometric measurements were performed in radiologic images of 94 patients with isolated ZAF, which were consecutively treated by closed reduction over transbuccal approach. Fracture types were allocated to the classifications of Rowe and Williams, Honig and Merten, Yamamoto et al., and Ozyazgan et al. The odds of achieving a satisfactory outcome were calculated for all categories. RESULTS Wide preoperative dislocation angles of more than 22° presented in M-type fractures (77.1%) more frequently compared to 2 fragments without the M-shape (33.3%) and one fragment (14.8%, p < 0.001). Favorable reduction outcome was significantly higher for M-shaped fractures than for differently configured fractures (83.3% vs. 30.4%, odds ratio 11.43, confidence interval 4.27-30.61). The rate of reduction in 100%-75% was most frequent for the Honig and Merten type I as well as Ozyazgan type IBV (both 85.4%, p < 0.001) and Yamamoto type II (84.2%, p < 0.001). CONCLUSION The classifications of Honig and Merten, Yamamoto et al., and Ozyazgan were quite applicable, and subgroups showed significant increments in reduction outcome. Our analysis emphasizes that the differentiation of two clinical relevant groups, M-shaped and variable arch fractures, is feasible to manage and efficient to determine the odds of reduction outcome.
Collapse
Affiliation(s)
- Johannes Buller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
| | - Elisa Zirk
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Andrea Grandoch
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Volker Maus
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany; Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias Zirk
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
31
|
Thiele OC, Nolte IM, Mischkowski RA, Safi AF, Perrin J, Zinser M, Zöller JE, Kreppel M. Craniomaxillofacial patient-specific CAD/CAM implants based on cone-beam tomography data - A feasibility study. J Craniomaxillofac Surg 2018; 46:1461-1464. [PMID: 29958732 DOI: 10.1016/j.jcms.2018.05.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/27/2018] [Accepted: 05/30/2018] [Indexed: 12/22/2022] Open
Abstract
Customized implants have simplified surgical procedures and have improved patient outcome in craniomaxillofacial surgery. Traditionally, patient-specific data is gathered by conventional computed tomography (CT). However, cone-beam CT (CBCT) can generate a 3D reconstruction of the area of interest with a lower dose of radiation at reduced cost. In this study, we investigated the feasibility of using CBCT data to design and generate customized implants for patients requiring craniomaxillofacial reconstruction. We used CBCT to generate 62 implants for 51 consecutive patients admitted to our department between January 2015 and December 2017. The indications for reconstruction and types of reconstruction were very variable. In all cases, the implants were well fitted and no implant-related complications were detected. Pre-surgical planning was faster and more efficient as we did not have to consult a radiologist. Although CBCT data is more difficult to process than conventional CT data for the implant provider, the clinical advantages are pronounced and we now use CBCT as standard in our department. In conclusion, we have shown that using CBCT to design and manufacture customized implants for reconstruction of the craniomaxillofacial area is feasible and recommend this approach to other departments.
Collapse
Affiliation(s)
- Oliver C Thiele
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, (Head: Prof. R. A. Mischkowski, MD, DDS), Ludwigshafen, Germany.
| | - Isabel M Nolte
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, (Head: Prof. R. A. Mischkowski, MD, DDS), Ludwigshafen, Germany
| | - Robert A Mischkowski
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, (Head: Prof. R. A. Mischkowski, MD, DDS), Ludwigshafen, Germany
| | - Ali F Safi
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital Cologne, (Head: Prof. J. E. Zöller, MD, DDS), Cologne, Germany
| | - Jason Perrin
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, (Head: Prof. D. Hänggi, MD), Mannheim, Germany
| | - Max Zinser
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital Cologne, (Head: Prof. J. E. Zöller, MD, DDS), Cologne, Germany
| | - Joachim E Zöller
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital Cologne, (Head: Prof. J. E. Zöller, MD, DDS), Cologne, Germany
| | - Matthias Kreppel
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital Cologne, (Head: Prof. J. E. Zöller, MD, DDS), Cologne, Germany
| |
Collapse
|
32
|
Zirk M, Zinser M, Buller J, Bilinsky V, Dreiseidler T, Zöller JE, Kreppel M. Supportive topical tranexamic acid application for hemostasis in oral bleeding events – Retrospective cohort study of 542 patients. J Craniomaxillofac Surg 2018; 46:932-936. [DOI: 10.1016/j.jcms.2018.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 12/26/2022] Open
|
33
|
Safi AF, Kauke M, Jung H, Timmer M, Borggrefe J, Persigehl T, Nickenig HJ, Zinser M, Maintz D, Kreppel M, Zöller J. Does volumetric measurement of cervical lymph nodes serve as an imaging biomarker for locoregional recurrence of oral squamous cell carcinoma? J Craniomaxillofac Surg 2018; 46:1013-1018. [DOI: 10.1016/j.jcms.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/13/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022] Open
|
34
|
Fridman E, Na'ara S, Agarwal J, Amit M, Bachar G, Villaret AB, Brandao J, Cernea CR, Chaturvedi P, Clark J, Ebrahimi A, Fliss DM, Jonnalagadda S, Kohler HF, Kowalski LP, Kreppel M, Liao CT, Patel SG, Patel RS, Robbins KT, Shah JP, Shpitzer T, Yen TC, Zöller JE, Gil Z. The role of adjuvant treatment in early-stage oral cavity squamous cell carcinoma: An international collaborative study. Cancer 2018; 124:2948-2955. [PMID: 29757457 DOI: 10.1002/cncr.31531] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Up to half of patients with oral cavity squamous cell carcinoma (OCSCC) have stage I to II disease. When adequate resection is attained, no further treatment is needed; however, re-resection or radiotherapy may be indicated for patients with positive or close margins. This multicenter study evaluated the outcomes and role of adjuvant treatment in patients with stage I to II OCSCC. METHODS Overall survival (OS), disease-specific survival, local-free survival, and disease-free survival rates were calculated with Kaplan-Meier analysis. RESULTS Of 1257 patients with T1-2N0M0 disease, 33 (2.6%) had positive margins, and 205 (16.3%) had close margins. The 5-year OS rate was 80% for patients with clear margins, 52% for patients with close margins, and 63% for patients with positive margins (P < .0001). In a multivariate analysis, age, depth of invasion, and margins were independent predictors of outcome. Close margins were associated with a >2-fold increase in the risk of recurrence (P < .0001). The multivariate analysis revealed that adjuvant treatment significantly improved the outcomes of patients with close/positive margins (P = .002 to .03). CONCLUSIONS Patients with stage I to II OCSCC and positive/close margins have poor long-term outcomes. For this population, adjuvant treatment may be associated with improved survival. Cancer 2018;124:2948-55. © 2018 American Cancer Society.
Collapse
Affiliation(s)
- Eran Fridman
- Rambam Healthcare Campus, Technion-Israel Institute of Technology, Haifa, Israel.,Laboratory for Applied Cancer Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shorook Na'ara
- Rambam Healthcare Campus, Technion-Israel Institute of Technology, Haifa, Israel.,Laboratory for Applied Cancer Research, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Moran Amit
- Rambam Healthcare Campus, Technion-Israel Institute of Technology, Haifa, Israel.,Laboratory for Applied Cancer Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gideon Bachar
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | | | - Jose Brandao
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Claudio R Cernea
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Ardalan Ebrahimi
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Dan M Fliss
- Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | - Hugo F Kohler
- Department of Head and Neck Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Matthias Kreppel
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | | | - Snehal G Patel
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - K Thomas Robbins
- Southern Illinois University School of Medicine, Carbondale, Illinois
| | - Jatin P Shah
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas Shpitzer
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | | | - Joachim E Zöller
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Ziv Gil
- Rambam Healthcare Campus, Technion-Israel Institute of Technology, Haifa, Israel.,Laboratory for Applied Cancer Research, Technion-Israel Institute of Technology, Haifa, Israel
| | | |
Collapse
|
35
|
Thiele OC, Kreppel M, Dunsche A, Eckardt AM, Ehrenfeld M, Fleiner B, Gaßling V, Gehrke G, Gerressen M, Gosau M, Gröbe A, Haßfeld S, Heiland M, Hoffmeister B, Hölzle F, Klein C, Krüger M, Kübler AC, Kübler NR, Kuttenberger JJ, Landes C, Lauer G, Martini M, Merholz ET, Mischkowski RA, Al- Nawas B, Nkenke E, Piesold JU, Pradel W, Rasse M, Rachwalski M, Reich RH, Rothamel D, Rustemeyer J, Scheer M, Schliephake H, Schmelzeisen R, Schramm A, Schupp W, Spitzer WJ, Stocker E, Stoll C, Terheyden H, Voigt A, Wagner W, Weingart D, Werkmeister R, Wiltfang J, Ziegler CM, Zöller JE. Current concepts in cleft care: A multicenter analysis. J Craniomaxillofac Surg 2018. [DOI: 10.1016/j.jcms.2018.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
36
|
Kauke M, Safi AF, Grandoch A, Nickenig HJ, Zöller J, Kreppel M. Sarcomas of the sinonasal tract. Head Neck 2018; 40:1279-1286. [PMID: 29443431 DOI: 10.1002/hed.25108] [Citation(s) in RCA: 4] [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: 05/03/2017] [Revised: 10/26/2017] [Accepted: 01/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sinonasal sarcomas are rare and heterogeneous in nature. Continuously collecting data influencing the prognosis is fundamental for optimizing therapeutic assessment of this highly destructive neoplasm. METHODS We conducted a single-institution retrospective cohort study considering 27 patients with sinonasal sarcoma. RESULTS The overall survival (OS) rates for 1 year and 5 years were calculated as 74% and 36%, respectively. Extent of the primary tumor (P = .010), nodal spread (P = .009), and age (P = .004) significantly reduced the OS. Disease-free survival (DFS) was significantly reduced by age (P = .003), extent of the primary (P = .006), nodal (P = .004), and hematogenous (P = .048) spread. Multimodal therapy including surgery improved the OS and DFS rates (P < .05). CONCLUSION Prognosis is poor due to late disease recognition. However, multimodal therapeutic regimens, including surgery, may improve the outcome.
Collapse
Affiliation(s)
- Martin Kauke
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Ali-Farid Safi
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Hans-Joachim Nickenig
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
37
|
Zirk M, Safi AF, Buller J, Nickenig HJ, Dreiseidler T, Zinser M, Drebber U, Zöller JE, Kreppel M. Lymph node ratio as prognosticator in floor of mouth squamous cell carcinoma patients. J Craniomaxillofac Surg 2018; 46:195-200. [DOI: 10.1016/j.jcms.2017.11.021] [Citation(s) in RCA: 11] [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: 07/12/2017] [Revised: 10/20/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022] Open
|
38
|
Gültekin SE, Aziz R, Heydt C, Sengüven B, Zöller J, Safi AF, Kreppel M, Buettner R. The landscape of genetic alterations in ameloblastomas relates to clinical features. Virchows Arch 2018; 472:807-814. [PMID: 29388014 PMCID: PMC5978850 DOI: 10.1007/s00428-018-2305-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/04/2018] [Accepted: 01/18/2018] [Indexed: 12/16/2022]
Abstract
Ameloblastoma is a mostly benign, but locally invasive odontogenic tumor eliciting frequent relapses and significant morbidity. Recently, mutually exclusive mutations in BRAF and SMO were identified causing constitutive activation of MAPK and hedgehog signaling pathways. To explore further such clinically relevant genotype-phenotype correlations, we here comprehensively analyzed a large series of ameloblastomas (98 paraffin block of 76 patients) with respect to genomic alterations, clinical presentation, and histological features collected from the archives of three different pathology centers in France, Germany, and Turkey. In good agreement with previously published data, we observed BRAF mutations almost exclusively in mandibular tumors, SMO mutations predominantly in maxillary tumors, and single mutations in EGFR, KRAS, and NRAS. KRAS, NRAS, PIK3CA, PTEN, CDKN2A, FGFR, and CTNNB1 mutations co-occurred in the background of either BRAF or SMO mutations. Strikingly, multiple mutations were exclusively observed in European patients, in solid ameloblastomas and were associated with a very high risk for recurrence. In contrast, tumors with a single BRAF mutation revealed a lower risk for relapse. We here establish a comprehensive landscape of mutations in the MAPK and hedgehog signaling pathways relating to clinical features of ameloblastoma. Our data suggest that ameloblastomas harboring single BRAF mutations are excellent candidates for neo-adjuvant therapies with combined BRAF/MEK inhibitors and that the risk of recurrence maybe stratified based on the mutational spectrum.
Collapse
Affiliation(s)
- Sibel Elif Gültekin
- Department of Oral Pathology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Reem Aziz
- Cologne Institute of Pathology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Carina Heydt
- Cologne Institute of Pathology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Burcu Sengüven
- Department of Oral Pathology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Joachim Zöller
- Clinic for Oral and Maxillofacial Surgery, University Hospital Cologne, Cologne, Germany
| | - Ali Farid Safi
- Clinic for Oral and Maxillofacial Surgery, University Hospital Cologne, Cologne, Germany
| | - Matthias Kreppel
- Clinic for Oral and Maxillofacial Surgery, University Hospital Cologne, Cologne, Germany
| | - Reinhard Buettner
- Cologne Institute of Pathology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| |
Collapse
|
39
|
Safi AF, Kauke M, Grandoch A, Nickenig HJ, Drebber U, Zöller J, Kreppel M. Clinicopathological parameters affecting nodal yields in patients with oral squamous cell carcinoma receiving selective neck dissection. J Craniomaxillofac Surg 2017; 45:2092-2096. [DOI: 10.1016/j.jcms.2017.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/12/2017] [Accepted: 08/14/2017] [Indexed: 12/17/2022] Open
|
40
|
Kauke M, Safi AF, Grandoch A, Nickenig HJ, Zöller J, Kreppel M. Volumetric analysis of keratocystic odontogenic tumors and non-neoplastic jaw cysts - Comparison and its clinical relevance. J Craniomaxillofac Surg 2017; 46:257-263. [PMID: 29233700 DOI: 10.1016/j.jcms.2017.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 10/10/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022] Open
Abstract
The keratocystic odontogenic tumor (KCOT) is capable of causing vast osseous destruction. Histopathological examination is pivotal for diagnosis. The diagnostic process can sometimes be hindered by tissue inflammation of KCOTs with loss of defining criteria, resulting in misdiagnosis as an odontogenic jaw cyst. We discuss the possible merits of volumetric analysis when facing this particular diagnostic dilemma and for pathophysiological characterization of KCOTs. We included 114 patients, of whom 27 were histopathologically diagnosed with a KCOT and 87 with dentigerous (n = 41) and periapical cyst (n = 46). Semiautomatic segmentation and radiological analysis of preoperative cone beam computed tomography (CBCT) image data was carried out using ITK-SNAP. The mean volumetric extent of KCOTs is significantly higher compared to non-neoplastic odontogenic jaw cysts (p = 0.001). The mean volume and standard deviation for KCOTs and non-neoplastic odontogenic jaw cysts was 10381 mm3 ± 6410 and 5813 mm3 ± 4425, respectively. Volumetric analysis reveals that KCOTs significantly exceed the mean size of non-neoplastic odontogenic jaw cysts, adding an argument in favor of the neoplastic nature of KCOTs. In the case of difficult histopathological examination, lesions with a size exceeding a value of about 3000 mm3 could be considered for close clinico-radiologic follow-up.
Collapse
Affiliation(s)
- Martin Kauke
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Ali-Farid Safi
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Hans-Joachim Nickenig
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
41
|
Kauke M, Safi AF, Kreppel M, Grandoch A, Nickenig HJ, Zöller JE, Dreiseidler T. Size distribution and clinicoradiological signs of aggressiveness in odontogenic myxoma-three-dimensional analysis and systematic review. Dentomaxillofac Radiol 2017; 47:20170262. [PMID: 29082773 DOI: 10.1259/dmfr.20170262] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Therapeutic assessment of odontogenic myxoma (OM) is poorly standardized. Unidimensional size criteria have shown to be unreliable in therapeutic decision-making. We evaluate the size distribution of OM and scan for associated clinicoradiological signs of aggressiveness. Additionally, we evaluate three-dimensional size delineation of OM aiming to improve future therapeutic assessment of this destructive neoplasm. METHODS Primarily, we reviewed the database "PubMed" for data concerning the size of OMs as radiologically determined. Afterwards, the impact of age, sex, locularity and location on the size was investigated by χ² test, Student's t-test and regression analysis. Furthermore, we statistically evaluated the impact of size on the occurrence of clinicoradiological signs of aggressiveness. Secondly, we approximated the volume of five unpublished cases of OM by semi-automatic image segmentation of cone-beam CT images. RESULTS Multilocular OMs were significantly larger than unilocular ones (p < 0.002). Age (0.042) and multilocularity (<0.002) significantly impacted size. Size was significantly associated with cortical perforation (0.032) and multilocularity (<0.002), further regression analysis revealed tooth resorption (0.019), cortical perforation (0.005) and multilocularity (<0.002) as significant predictors of size. Employing the volume as a mean of comparison, we found that the biggest OM (38.42 ml; multilocular) was 124 times larger than the smallest (0.31 ml; unilocular). However, using the maximum diameter (cm) as a surrogate for size, the biggest lesion (6.3) was only 5.25 times larger than the smallest (1.2). CONCLUSIONS Locularity and volumetric size characterization might help in therapeutic decision-making and could help to improve our understanding of OM.
Collapse
Affiliation(s)
- Martin Kauke
- 1 Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Ali-Farid Safi
- 1 Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- 1 Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Andrea Grandoch
- 1 Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Hans-Joachim Nickenig
- 1 Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- 1 Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Timo Dreiseidler
- 1 Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.,2 Dreifaltigkeits-Krankenhaus Wesseling, University Teaching hospital, Wesseling, Germany
| |
Collapse
|
42
|
Safi AF, Grandoch A, Nickenig HJ, Zöller JE, Kreppel M. Importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the buccal mucosa. Head Neck 2017; 39:2488-2493. [DOI: 10.1002/hed.24922] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/23/2017] [Accepted: 07/14/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ali-Farid Safi
- Department of Oral and Craniomaxillofacial Plastic Surgery; University of Cologne; Cologne Germany
- Centre of Integrated Oncology (CIO); Cologne-Bonn Germany
| | - Andrea Grandoch
- Department of Oral and Craniomaxillofacial Plastic Surgery; University of Cologne; Cologne Germany
- Centre of Integrated Oncology (CIO); Cologne-Bonn Germany
| | - Hans-Joachim Nickenig
- Department of Oral and Craniomaxillofacial Plastic Surgery; University of Cologne; Cologne Germany
- Centre of Integrated Oncology (CIO); Cologne-Bonn Germany
| | - Joachim E. Zöller
- Department of Oral and Craniomaxillofacial Plastic Surgery; University of Cologne; Cologne Germany
- Centre of Integrated Oncology (CIO); Cologne-Bonn Germany
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial Plastic Surgery; University of Cologne; Cologne Germany
- Centre of Integrated Oncology (CIO); Cologne-Bonn Germany
| |
Collapse
|
43
|
Safi AF, Kauke M, Grandoch A, Nickenig HJ, Zöller JE, Kreppel M. Analysis of clinicopathological risk factors for locoregional recurrence of oral squamous cell carcinoma – Retrospective analysis of 517 patients. J Craniomaxillofac Surg 2017; 45:1749-1753. [DOI: 10.1016/j.jcms.2017.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/26/2017] [Accepted: 07/20/2017] [Indexed: 01/20/2023] Open
|
44
|
Safi AF, Kauke M, Grandoch A, Nickenig HJ, Drebber U, Zöller J, Kreppel M. The importance of log odds of positive lymph nodes for locoregional recurrence in oral squamous cell carcinoma. Oral Oncol 2017; 72:48-55. [DOI: 10.1016/j.oraloncology.2017.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/20/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
|
45
|
Dreiseidler T, Lentzen MP, Zirk M, Safi AF, Zoeller JE, Kreppel M. Systematic three-dimensional analysis of wafer-based maxillary repositioning procedures in orthognathic surgery. J Craniomaxillofac Surg 2017; 45:1828-1834. [PMID: 28927954 DOI: 10.1016/j.jcms.2017.08.022] [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: 12/15/2016] [Revised: 07/20/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Little is known about the three-dimensional (3D) transfer accuracy in maxillary repositioning procedures based on conventionally manufactured dental-mounted wafers. The purpose of the present study was a systematic 3D analysis for wafer-based maxillary positioning in orthognathic surgery. MATERIALS AND METHODS A total of 92 patients underwent Le Fort I in addition to mandibular bilateral sagittal split osteotomies (BSSO). Alignment of the pre- and postsurgical CBCT data sets allowed measuring maxillary position changes in axial, sagittal and transversal directions. RESULTS The highest achieved absolute transfer inaccuracies were 1.37 mm, ±0.84 in the sagittal direction, followed by 1.15 mm, ±0.69 in the axial, as well as 1.05 mm, ±0.79 in the transversal direction. The largest relative deviations could be found for repositions in the transversal plane (109.4%, ±4.5), followed by the axial (66.2%, ±51.5) and sagittal plane (49.3%, ±2.2). Significant transfer accuracy differences of repositioning procedures in the sagittal direction, mainly advancement procedures, could be detected if performed with (1.75 mm, ±0.90) or without (1.18 mm, ±0.78) additional rotational correction component. No significant differences were found between unidirectional and multidirectional maxillary correction procedures. CONCLUSION The present study for the first time delivers systematic 3D accuracy data of wafer-based maxillary positioning procedures, attesting to its feasibility but also further encouraging the search for improvement strategies.
Collapse
Affiliation(s)
- Timo Dreiseidler
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany.
| | - Max-Philipp Lentzen
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany
| | - Matthias Zirk
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany
| | - Ali-Farid Safi
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany
| | - Joachim E Zoeller
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany
| | - Matthias Kreppel
- University of Cologne, Dept. of Craniomaxillofacial and Plastic Surgery (Head: Professor Dr. Dr. Joachim E. Zoeller), Kerpener Straße 62, D-50924 Cologne, Germany
| |
Collapse
|
46
|
Dreiseidler T, Ritter L, Zirk M, Kreppel M, Richter DF, Zoeller JE. Distance-dependent accuracy in Le Fort I maxillary repositioning procedures. Br J Oral Maxillofac Surg 2017; 55:815-821. [PMID: 28843967 DOI: 10.1016/j.bjoms.2017.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
It has been hypothesised that, in maxillary repositioning procedures, longer distances correlate with less accurate transfers and particularly the repositioning forces of facial skin and muscles that increase exponentially. However, this has not to our knowledge been confirmed. The purpose of this study was to search for differences in the accuracy of transfer from maxillary repositioning procedures parallel to the three orthogonal planes and with respect to three different anatomical landmarks of the first molar left and right (M1L and M1R) and the first incisor (I). Cone-beam computed tomography (CT) datasets taken before and after operation for 92 patients who had Le Fort I maxillary repositioning procedures were aligned to measure the changes in the maxillary position in the axial, sagittal, and transverse directions. Differences between planned distances and those achieved were calculated and analysed with Pearsons correlation coefficient. The strongest significant correlations between the extent of planned repositioning distances and achieved differences (error) were detected in the sagittal plane for the anatomical landmarks of the right (M1R) and left first molar (M1L). Correlations became weaker if a limited planned distance ranging from 0-4mm was compared with a complete observed range that reached up to 12mm. Our results show for the first time to our knowledge that the accuracy of transfer of wafer-based maxillary positioning procedures depends on the distance being moved. Longer distances correlate with less accuracy, particularly in the sagittal plane and in the first molar region.
Collapse
Affiliation(s)
- T Dreiseidler
- Dept. of Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany.
| | | | - M Zirk
- Dept. of Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - M Kreppel
- Dept. of Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - D F Richter
- Dept. of Plastic Surgery, Dreifaltigkeitskrankenhaus Wesseling, Germany
| | - J E Zoeller
- Dept. of Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| |
Collapse
|
47
|
Zirk M, Kreppel M, Buller J, Pristup J, Peters F, Dreiseidler T, Zinser M, Zöller JE. The impact of surgical intervention and antibiotics on MRONJ stage II and III – Retrospective study. J Craniomaxillofac Surg 2017; 45:1183-1189. [DOI: 10.1016/j.jcms.2017.05.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/22/2017] [Accepted: 05/29/2017] [Indexed: 01/23/2023] Open
|
48
|
Safi AF, Grandoch A, Nickenig HJ, Zöller JE, Kreppel M. The importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the tongue. J Craniomaxillofac Surg 2017; 45:1058-1061. [DOI: 10.1016/j.jcms.2017.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/20/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022] Open
|
49
|
Safi AF, Grandoch A, Dreiseidler T, Nickenig HJ, Zöller J, Kreppel M. Can cyst volume be used to stratify risk of complications following cyst defect reconstruction with iliac crest graft? J Craniomaxillofac Surg 2017; 45:1165-1169. [PMID: 28610931 DOI: 10.1016/j.jcms.2017.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 04/23/2017] [Accepted: 05/10/2017] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The role of the volume of radicular and dentigerous cysts on clinical symptoms is unclear and potentially may predict development of pre- and postoperative complications, especially after cystectomies with large bony defects. Therefore the aim of this study was to assess pre- and postoperative symptoms associated to the volume of jaw cysts. MATERIAL AND METHODS Retrospective chart review of 111 patients with follicular or dentigerous cysts from 2008-2012. Anterior iliac crest grafts were used to fill defects after cystectomy. χ2-test was performed to analyze associations between two qualitative variables. Binary logistic regression analysis was used as multivariate analysis. P-values p < 0.05 were considered as significant. Volume measurement was performed in a semiautomatic segmentation method with the software "ITK-Snap". RESULTS Postoperative hypaesthesia correlated significantly with histology (p = 0.025) and localization (p = 0.006). Volume was associated significantly with preoperative hypaesthesia (p = 0.052), postoperative hypaesthesia (p < 0.001), wound healing complications (p < 0.001) and length of wound healing complications (p = 0.001). Multivariate analysis identified volume as independent risk factor for postoperative hypaesthesia (p = 0.015). CONCLUSIONS Volume analysis appears to be a method that allows risk stratification after surgery of jaw cysts. Therefore we recommend a precise treatment planning with the means of volume analysis to improve therapy outcome of patients with jaw cysts.
Collapse
Affiliation(s)
- Ali-Farid Safi
- Department for Oral and Craniomaxillofacial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Kerpener Str. 62, Germany.
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Kerpener Str. 62, Germany
| | - Timo Dreiseidler
- Department for Oral and Maxillofacial Surgery, Johannes-Wesling Krankenhaus, Mühlenkreiskliniken, Minden, Germany
| | - Hans-Joachim Nickenig
- Department for Oral and Craniomaxillofacial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Kerpener Str. 62, Germany
| | - Joachim Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Kerpener Str. 62, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Kerpener Str. 62, Germany
| |
Collapse
|
50
|
Safi AF, Richter MT, Rothamel D, Nickenig HJ, Scheer M, Zöller J, Kreppel M. Influence of the volume of soft tissue herniation on clinical symptoms of patients with orbital floor fractures. J Craniomaxillofac Surg 2016; 44:1929-1934. [PMID: 27756551 DOI: 10.1016/j.jcms.2016.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/11/2016] [Accepted: 09/19/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION One of the most important complications of orbital floor fractures is diplopia and restricted ocular movement. The role of the volume of soft tissue herniation on these clinical symptoms after orbital floor fractures is unclear and potentially may predict development of persistent clinical symptoms. Therefore the aim of this study was to assess pre- and postoperative complications associated to the volume of soft tissue herniation, with special interest to diplopia and bulbus motility impairment. MATERIAL AND METHODS 204 untreated patients with orbital floor fractures from 2009 to 2011 were included in this retrospective study. Contingency tables and χ2-test were performed to analyze associations between two qualitative variables. p-Values p < 0.05 were considered as significant. Volume measurement was performed in a semiautomatic segmentation method with the software "ITK-Snap". RESULTS The volume of soft tissue herniation correlated significantly with pre- and postoperative diplopia (p = 0.003; p = 0.002), persistent diplopia (p = 0.009) as well as pre- and postoperative bulbus motility impairment (both p < 0.001). Furthermore we found out significant associations between the volume of soft tissue herniation and pre- and postoperative complications depending on fracture type and reconstruction technique. CONCLUSIONS Volume measurement of soft tissue herniation may help to predict postoperative complications, particularly bulbus motility restriction and persistent diplopia. The risk for these symptoms rises with increasing volume of soft tissue herniation after orbital floor fractures. Therefore we recommend for these patients within indication an early repair and/or closer observation.
Collapse
Affiliation(s)
- Ali-Farid Safi
- Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
| | - Marie-Theres Richter
- Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Daniel Rothamel
- Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Hans-Joachim Nickenig
- Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Martin Scheer
- Department for Oral and Maxillofacial Surgery, Johannes-Wesling Krankenhaus, Mühlenkreiskliniken Minden, Germany
| | - Joachim Zöller
- Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|